Individual
MAC ANDREW JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2919 VALMONT RD, STE 204, BOULDER, CO 80301
(303) 938-1110
(303) 938-1145
Mailing address
2919 VALMONT RD, STE 204, BOULDER, CO 80301
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
CO-2847
CO
Other
Enumeration date
10/02/2024
Last updated
10/02/2024
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