Basic Information
Provider Information
NPI: 1245676287
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REID
FirstName: JESSICA
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 155 INVERNESS DR W
Address2: SUITE 200
City: ENGLEWOOD
State: CO
PostalCode: 801125095
CountryCode: US
TelephoneNumber: 3037939692
FaxNumber: 3038890838
Practice Location
Address1: 155 INVERNESS DR W
Address2: SUITE 200
City: ENGLEWOOD
State: CO
PostalCode: 801125095
CountryCode: US
TelephoneNumber: 3037939692
FaxNumber: 3038890838
Other Information
ProviderEnumerationDate: 05/16/2013
LastUpdateDate: 11/04/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XLPC.0012160COY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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