Provider Demographics
NPI:1053888198
Name:PAUL, JESSICA (MS, LPCC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPCC
Mailing Address - Street 1:1621 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1044
Mailing Address - Country:US
Mailing Address - Phone:407-921-9984
Mailing Address - Fax:
Practice Address - Street 1:3497 IRIS CT
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1827
Practice Address - Country:US
Practice Address - Phone:720-552-1461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ114432355S0801X
COLPCC.0021867101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant