Healthcare Provider Details

I. General information

NPI: 1164364618
Provider Name (Legal Business Name): TAYLOR MARIE JACKSON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 W 20TH ST STE C
GREELEY CO
80634-6566
US

IV. Provider business mailing address

4025 RAWLINS ST
CHEYENNE WY
82001-1900
US

V. Phone/Fax

Practice location:
  • Phone: 970-672-4667
  • Fax:
Mailing address:
  • Phone: 970-672-4667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC.0024447
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: