Active NPI
Jennifer Lynette Jackson-Gustafson, M.A., L.P.C.
- Professional Counselor
- Aurora, CO
National Provider Identifier
1104214063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 0003899
- Practice address
- 6240 S Main St
Aurora, CO 80016-5376 - Phone
- (720) 274-5270
- NPI assigned
- Dec 30, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0003899 | CO | Primary |
Addresses
Primary practice location
6240 S Main St
Aurora, CO 80016-5376
Mailing address
6240 S Main St
Aurora, CO 80016-5376
Phone (720) 274-5270
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0003899 | CO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1419897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1419897600000",
"number": "1104214063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6240 S MAIN ST",
"city": "AURORA",
"state": "CO",
"postal_code": "800165376",
"telephone_number": "720-274-5270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6240 S MAIN ST",
"city": "AURORA",
"state": "CO",
"postal_code": "800165376",
"telephone_number": "720-274-5270"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON-GUSTAFSON",
"first_name": "JENNIFER",
"middle_name": "LYNETTE",
"name_prefix": "Mrs.",
"credential": "M.A., L.P.C.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-12-30",
"last_updated": "2014-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CO",
"license": "0003899",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Aurora, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.