Provider Demographics
NPI:1104080571
Name:JACKMAN, NISSA MACRAY (LMFT, ATR)
Entity type:Individual
Prefix:MS
First Name:NISSA
Middle Name:MACRAY
Last Name:JACKMAN
Suffix:
Gender:
Credentials:LMFT, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9085 E MISSISSIPPI AVE APT A104
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-2069
Mailing Address - Country:US
Mailing Address - Phone:720-213-6773
Mailing Address - Fax:
Practice Address - Street 1:9085 E MISSISSIPPI AVE APT A104
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-2069
Practice Address - Country:US
Practice Address - Phone:510-851-4552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01AVOtherMEDICAL