Provider Demographics
NPI:1104387596
Name:MCCOLGAN, JENNIFER LYNN (MA, LPC, CCDP-D)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:MCCOLGAN
Suffix:
Gender:F
Credentials:MA, LPC, CCDP-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 RUSTIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:MO
Mailing Address - Zip Code:63050-3729
Mailing Address - Country:US
Mailing Address - Phone:314-329-5410
Mailing Address - Fax:
Practice Address - Street 1:3828 RUSTIC VIEW DR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:MO
Practice Address - Zip Code:63050-3729
Practice Address - Country:US
Practice Address - Phone:314-329-5410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017013044101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional