Doctor Name: | MR. THADDEUS COLLINS JESSEN |
NPI Number: | 1669433116 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 3535 |
Business Practice Address: | 4601 Corbett Dr Ft Collins, CO - 80528 |
Business Phone Number: | 9702074800 |
Business Fax Number: | 9702074860 |
Mailing Address: | 4601 Corbett Dr, FT COLLINS |
State: | CO |
Postal Code: | 80528 |
Phone Number: | 9702074800 |
Fax Number: | 9702074860 |
NPI Enumeration Date: | 03/31/2006 |
NPI Last Update Date: | 03/07/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 3535 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |