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General NPI Number Information
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NPI Number | 1093855090
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Entity Type | Individual
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Provider Name | LAURAN JACKS LCSW, PSYD.
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Gender | Female
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 6438 S QUEBEC ST STE 314
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City | CENTENNIAL
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State | CO
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Zip | 80111-7602
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Country | US
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Telephone | 303-941-1325
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Fax | 303-987-0424
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Provider Business Mailing Address
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Address Line | 8618 COLONIAL DR
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City | LONE TREE
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State | CO
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Zip | 80124-9743
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Country | US
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Telephone | 303-941-1325
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Fax | 303-987-0424
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 992853
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW71932
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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