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General NPI Number Information
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NPI Number | 1154176477
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Entity Type | Individual
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Provider Name | JARED ANDERSON
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Gender | Male
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Dates
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Enumeration Date | 04/19/2024
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Last Update Date | 04/19/2024
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Provider Practice Location Address
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Address Line | 8120 SHERIDAN BLVD STE 315C
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City | ARVADA
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State | CO
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Zip | 80003-6160
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Country | US
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Telephone | 720-523-3189
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Fax |
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Provider Business Mailing Address
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Address Line | 12165 CLAUDE CT UNIT 203
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City | NORTHGLENN
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State | CO
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Zip | 80241-3310
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Country | US
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Telephone | 614-352-7859
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFTC.0014590
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License Number State | CO
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