Jacqueline R Anderson, PHD, NCSP, LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY.0005796 Issued in CO

Practice address

12303 Airport Way Ste 125
Broomfield, CO 80021-2729

Phone

(970) 310-3406

NPI assigned

Jun 7, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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  • NPI 1588038681

  CO

  Medicare reassignment NPD
• Heart Centered Counseling, PC

  • Mental Health Counselor
  • Colorado Springs, CO
  • NPI 1558158584
  NPD
• Heart Centered Counseling, PC

  • Mental Health Counselor
  • Wheat Ridge, CO
  • NPI 1679114979
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722384000000",
    "number": "1386137016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12303 AIRPORT WAY STE 125",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800212729",
            "telephone_number": "970-310-3406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12303 AIRPORT WAY STE 125",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800212729",
            "telephone_number": "970-310-3406"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "215 W Oak St Fl 4",
            "address_purpose": "LOCATION",
            "city": "Fort Collins",
            "state": "CO",
            "postal_code": "805212734",
            "country_code": "US",
            "telephone_number": "970-310-3406",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JACQUELINE",
        "middle_name": "R",
        "credential": "PHD, NCSP, LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-07",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "CO",
            "license": "PSY.0005796",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CO",
            "license": "PSY.0005796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carly Amurao, AU.D.
• Amy Annesley, LCSW LLC
• Anchor Physical Therapy, P.C.
• Laura Michelle Andersen, RDN
• Daniel R. Anderson, DDS
• Kelley Anderson
• Eric Andrade
• Angels Advocate Home Care, LLC
• Angels Advocate Home Care, LLC
• Amy Lee Annesley, L.C.S.W.

• All providers in Broomfield, CO
• Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.