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General NPI Number Information
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NPI Number | 1417222134
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Entity Type | Individual
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Provider Name | DANIEL JACKSON LMFT
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Gender | Male
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 375 E HORSETOOTH RD BUILDING 3, SUITE #101
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City | FORT COLLINS
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State | CO
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Zip | 80525-3155
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Country | US
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Telephone | 765-744-5884
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Fax |
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Provider Business Mailing Address
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Address Line | 375 E HORSETOOTH RD BUILDING 3, SUITE #101
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City | FORT COLLINS
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State | CO
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Zip | 80525-3155
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Country | US
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Telephone | 765-744-5884
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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 | 1317
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1244
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License Number State | TN
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