Individual
JAKE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
1333 IRIS AVE, BOULDER, CO 80304-2226
(303) 443-8500
Mailing address
13830 DOGLEG LN, BROOMFIELD, CO 80023-9571
(720) 227-1206
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/18/2013
Last updated
02/18/2013
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