Individual
AUDRA NICOLE JALBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1570 E NORTHERN AVE STE C, KINGMAN, AZ 86409-2483
(928) 263-1045
Mailing address
1300 N 17TH AVE, GREELEY, CO 80631-9584
(970) 347-2120
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008058
—
AZ
05
—
0580630
—
CO
Enumeration date
07/25/2016
Last updated
09/30/2020
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