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General NPI Number Information
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NPI Number | 1487967915
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Entity Type | Individual
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Provider Name | JACQUELYN PALMER MOFFITT MA, LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 07/26/2010
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Last Update Date | 07/26/2010
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Provider Practice Location Address
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Address Line | 2718 HARTSEL CT
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City | LOVELAND
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State | CO
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Zip | 80538-2932
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Country | US
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Telephone | 970-669-2430
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Fax | 970-667-8625
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Provider Business Mailing Address
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Address Line | 2718 HARTSEL CT
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City | LOVELAND
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State | CO
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Zip | 80538-2932
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Country | US
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Telephone | 970-669-2430
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Fax | 970-667-8625
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 634
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License Number State | CO
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