Basic Information
| Provider Information | |||||||||
| NPI: | 1164895751 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIES | ||||||||
| FirstName: | JASON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4141 E DICKENSON PL | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802226012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035046500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1255 LEE ST | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802154542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202664444 | ||||||||
| FaxNumber: | 3032322399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2015 | ||||||||
| LastUpdateDate: | 08/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFTC.0013459 | CO | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.