Provider Demographics
NPI:1972210599
Name:VANDERLOO, JACIE MAE (LPCC)
Entity type:Individual
Prefix:
First Name:JACIE
Middle Name:MAE
Last Name:VANDERLOO
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7830 W ALAMEDA AVE
Mailing Address - Street 2:STE. 103 PMB 335
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226
Mailing Address - Country:US
Mailing Address - Phone:720-328-6556
Mailing Address - Fax:
Practice Address - Street 1:200 UNION BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1831
Practice Address - Country:US
Practice Address - Phone:720-328-6556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020166101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor