Provider Demographics
NPI:1215335120
Name:JUNG, PAULA (LCSW)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:JUNG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29767 GI GI RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439
Mailing Address - Country:US
Mailing Address - Phone:303-989-4357
Mailing Address - Fax:303-988-2017
Practice Address - Street 1:421 ZANG ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1052
Practice Address - Country:US
Practice Address - Phone:303-989-4357
Practice Address - Fax:303-988-2017
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9920411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical