Basic Information
| Provider Information | |||||||||
| NPI: | 1427375963 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DURRETT | ||||||||
| FirstName: | JACLYN | ||||||||
| MiddleName: | TAYLER | ||||||||
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| Credential: | M.A., LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 40 | ||||||||
| Address2: | |||||||||
| City: | GLENWOOD SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816020040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9709452241 | ||||||||
| FaxNumber: | 9709455523 | ||||||||
| Practice Location | |||||||||
| Address1: | 395 E LIONSHEAD CIR | ||||||||
| Address2: | |||||||||
| City: | VAIL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816575354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704760930 | ||||||||
| FaxNumber: | 9704760535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2010 | ||||||||
| LastUpdateDate: | 08/26/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 5812 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.