Provider Demographics
NPI:1326634759
Name:FREDERICK, JON (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 W 107TH PL UNIT E
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-7719
Mailing Address - Country:US
Mailing Address - Phone:725-867-0252
Mailing Address - Fax:
Practice Address - Street 1:155 S MADISON ST STE 306
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3014
Practice Address - Country:US
Practice Address - Phone:725-867-0252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-20
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional