MEDICARE: BARBARA ANN JACKSON MA, LPC

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	101YP2500X	Professional Counselor	2265	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2265	OTHER	CO	LICENSED PROFESSIONAL COUNSELOR

General Provider Information

NPI Number	:	1780900720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA ANN JACKSON MA, LPC

Provider Business Mailing Address
First Line	:	777 S WADSWORTH BLVD
Second Line	:	BUILDING 2 SUITE 106
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-4550
Country	:	US
Telephone Number	:	303-884-5826
Fax Number	:	303-979-6811

Provider Business Practice Location Address
First Line	:	777 SOUTH WADSWORTH BLVD
Second Line	:	BUILDING 2 SUITE 106
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-4550
Country	:	US
Telephone Number	:	303-884-5826
Fax Number	:	303-979-6811

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

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	12/08/2020

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