Provider Demographics
NPI:1356484216
Name:FRIESEMA, JASON SCOTT (LPC, CAC III)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:SCOTT
Last Name:FRIESEMA
Suffix:
Gender:M
Credentials:LPC, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 TELLER LN
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-1359
Mailing Address - Country:US
Mailing Address - Phone:719-578-9888
Mailing Address - Fax:719-578-9869
Practice Address - Street 1:1011 N WEBER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2466
Practice Address - Country:US
Practice Address - Phone:719-578-9888
Practice Address - Fax:719-578-9869
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6293101YA0400X
CO4514101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional