Provider Demographics
NPI:1043331374
Name:ENGET, JODY L (MFT)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:L
Last Name:ENGET
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12163 SOUTH PERRY PARK ROAD
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CO
Mailing Address - Zip Code:80118
Mailing Address - Country:US
Mailing Address - Phone:303-681-2400
Mailing Address - Fax:303-681-2401
Practice Address - Street 1:12163 SOUTH PERRY PARK ROAD
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CO
Practice Address - Zip Code:80118
Practice Address - Country:US
Practice Address - Phone:303-681-2400
Practice Address - Fax:303-681-2401
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT 743106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95072861Medicaid