Provider Demographics
NPI:1285957837
Name:DIEBEL, JENNIFER LYNN (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:DIEBEL
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 1:260 E CORNWALL CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-1160
Mailing Address - Country:US
Mailing Address - Phone:303-931-4284
Mailing Address - Fax:
Practice Address - Street 1:5370 MANHATTAN CIR
Practice Address - Street 2:SUITE 203
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4250
Practice Address - Country:US
Practice Address - Phone:303-931-4284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5867101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional