MEDICARE: KRISTEN JACKSON PSYCHOTHERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1497427041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN JACKSON PSYCHOTHERAPIST

Provider Business Mailing Address
First Line	:	9753 E 60TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-2394
Country	:	US
Telephone Number	:	303-931-0606
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 SOUTH COLORADO BLVD.
Second Line	:	NORTH TOWER # 1356
City	:	GLENDALE
State	:	CO
Zip	:	80246
Country	:	US
Telephone Number	:	303-931-0606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2021
Last Update Date	:	10/01/2021

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