Provider Demographics
NPI:1356688683
Name:MORTENSEN, JESSICA ANNE (BA, MA, LPC, CAS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:MORTENSEN
Suffix:
Gender:F
Credentials:BA, MA, LPC, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 SHERIDAN BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80214-3018
Mailing Address - Country:US
Mailing Address - Phone:720-295-9893
Mailing Address - Fax:
Practice Address - Street 1:2980 SHERIDAN BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80214-3018
Practice Address - Country:US
Practice Address - Phone:720-295-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0017088101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional