Provider Demographics
NPI:1457021263
Name:MERTENS, JOHN PAUL (MA, MDIV, LPCC, NCC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:MERTENS
Suffix:
Gender:M
Credentials:MA, MDIV, LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7062 GRAND PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-8748
Mailing Address - Country:US
Mailing Address - Phone:719-321-6906
Mailing Address - Fax:
Practice Address - Street 1:1465 KELLY JOHNSON BLVD STE 305
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3947
Practice Address - Country:US
Practice Address - Phone:719-722-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0017980101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional