Provider Demographics
NPI:1093227670
Name:FERGEN, JADI (MA, LPCC, NCC)
Entity Type:Individual
Prefix:
First Name:JADI
Middle Name:
Last Name:FERGEN
Suffix:
Gender:F
Credentials:MA, LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 DEL PAZ DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1704
Mailing Address - Country:US
Mailing Address - Phone:605-484-6647
Mailing Address - Fax:
Practice Address - Street 1:4297 AUSTIN BLUFFS PKWY STE 204
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2953
Practice Address - Country:US
Practice Address - Phone:719-235-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0015439101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health