Individual
JACLYN A DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
145 1ST ST, FORT LUPTON, CO 80621-2002
(303) 857-6365
(303) 857-2123
Mailing address
145 1ST ST, FORT LUPTON, CO 80621-2002
(303) 857-6365
(303) 857-2123
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
7241
CO
1041C0700X
Clinical Social Worker
Primary
1654
CO
Other
Enumeration date
11/09/2010
Last updated
11/09/2010
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