| Organization Name: | JEFFERSON CENTER FOR MENTAL HEALTH |
| NPI Number: | 1154627503 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID A GOFF (CFO) |
| Mailing Address: | 28577 Buffalo Road Ste 240 Evergreen |
| State: | CO US |
| Postal Code: | 80439 |
| Phone Number: | 3034250300 |
| Fax Number: | 3034325073 |
| NPI Enumeration Date: | 02/02/2011 |
| NPI Last Update Date: | 02/02/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 150413 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |