Basic Information
| Provider Information | |||||||||
| NPI: | 1457471096 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HENNINGER | ||||||||
| OtherFirstName: | JUDY | ||||||||
| OtherMiddleName: | MATRATET | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 155 INVERNESS DR W STE 200 | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801125000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037308858 | ||||||||
| FaxNumber: | 3038890838 | ||||||||
| Practice Location | |||||||||
| Address1: | 831 S PERRY ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CASTLE ROCK | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801041919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037308858 | ||||||||
| FaxNumber: | 3038890838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 10/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2988 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | LPC-2988 | CO | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 10687564 | 05 | CO | MEDICAID |