Doctor Name: | MR. JOHN HAROLD JORGENSEN |
NPI Number: | 1033104740 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | 991975 |
Business Practice Address: | 4102 Pinion Dr Usaf Academy, CO - 808402502 |
Business Phone Number: | 7193335372 |
Business Fax Number: | 7193336711 |
Mailing Address: | 4102 Pinion Dr, USAF ACADEMY |
State: | CO |
Postal Code: | 808402502 |
Phone Number: | 7193335372 |
Fax Number: | 7193336711 |
NPI Enumeration Date: | 09/19/2005 |
NPI Last Update Date: | 06/06/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 991975 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |