Healthcare Provider Details

I. General information

NPI: 1174561641
Provider Name (Legal Business Name): LAURIE BERGER-JACKSON PHD CLINICAL PSYCHOL
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: LAURIE C BERGER

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4498 E PHILLIPS PL
LITTLETON CO
80122
US

IV. Provider business mailing address

4498 E PHILLIPS PL
LITTLETON CO
80122
US

V. Phone/Fax

Practice location:
  • Phone: 720-312-8691
  • Fax: 303-694-1907
Mailing address:
  • Phone: 720-312-8691
  • Fax: 303-694-1907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2931
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number582AC
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2653
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: