Jacqueline Rae Anderson, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

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

Last updated

Nov 6, 2026By the provider in NPPES

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

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Heart Centered Counseling, PC

  dba LifeStance Health

  • Mental Health Counselor
  • Fort Collins, CO
  • NPI 1588038681
  Medicare reassignment NPD
• Heart Centered Counseling, PC

  dba LifeStance Health

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

  dba LifeStance Health

  • 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": "1793923200000",
    "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": "RAE",
        "credential": "LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-07",
        "last_updated": "2026-11-06",
        "certification_date": "2026-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "PSY.0005796",
            "primary": true
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "CO",
            "license": "PSY.0005796",
            "primary": false
        }
    ],
    "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.

• Clinical Psychologist in Broomfield, CO
• Providers in Broomfield, CO by specialty
• Clinical Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2026; 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.