Provider Demographics
NPI:1154164929
Name:MCKENNA, JASMIN
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:
Last Name:MCKENNA
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 S REED CT APT 3-404
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-4478
Mailing Address - Country:US
Mailing Address - Phone:641-430-9023
Mailing Address - Fax:
Practice Address - Street 1:90 MADISON ST STE 302
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5412
Practice Address - Country:US
Practice Address - Phone:720-388-8263
Practice Address - Fax:720-216-2276
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014662106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist