Provider Demographics
NPI:1447709308
Name:MABEN, JACQUELINE LEIGH (MA, LPC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:LEIGH
Last Name:MABEN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 LEE ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-4542
Mailing Address - Country:US
Mailing Address - Phone:720-530-7579
Mailing Address - Fax:
Practice Address - Street 1:1255 LEE ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-4542
Practice Address - Country:US
Practice Address - Phone:720-266-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0106180101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health