Provider Demographics
NPI:1366709966
Name:ANDERSON, JARAD LYN (BS)
Entity type:Individual
Prefix:MR
First Name:JARAD
Middle Name:LYN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3729 DAHLIA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-1017
Mailing Address - Country:US
Mailing Address - Phone:970-310-7355
Mailing Address - Fax:
Practice Address - Street 1:3729 DAHLIA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207-1017
Practice Address - Country:US
Practice Address - Phone:970-310-7355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health