Healthcare Provider Details

I. General information

NPI: 1932076585
Provider Name (Legal Business Name): JACQUELINE MERYL HAMBRICK PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 TERRY ST STE 320
LONGMONT CO
80501-5490
US

IV. Provider business mailing address

350 TERRY ST STE 320
LONGMONT CO
80501-5490
US

V. Phone/Fax

Practice location:
  • Phone: 970-310-3406
  • Fax: 888-965-4615
Mailing address:
  • Phone: 970-310-3406
  • Fax: 888-965-4615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSYC.00016250
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: