Provider Demographics
NPI:1154176477
Name:ANDERSON, JARED
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12165 CLAUDE CT UNIT 203
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80241-3310
Mailing Address - Country:US
Mailing Address - Phone:614-352-7859
Mailing Address - Fax:
Practice Address - Street 1:8120 SHERIDAN BLVD STE 315C
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-6160
Practice Address - Country:US
Practice Address - Phone:720-523-3189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014590106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist