| Doctor Name: | JACLYN A DAVIS |
| NPI Number: | 1750682621 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 7241 |
| Business Practice Address: | 145 1st St Fort Lupton, CO - 806212002 |
| Business Phone Number: | 3038576365 |
| Business Fax Number: | 3038572123 |
| Mailing Address: | 145 1st St, FORT LUPTON |
| State: | CO |
| Postal Code: | 806212002 |
| Phone Number: | 3038576365 |
| Fax Number: | 3038572123 |
| NPI Enumeration Date: | 11/09/2010 |
| NPI Last Update Date: | 11/09/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 7241 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |