Provider Demographics
NPI:1467938589
Name:ZIEGENHAGEN, MARK MAXWELL (MA, MFTC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:MAXWELL
Last Name:ZIEGENHAGEN
Suffix:
Gender:M
Credentials:MA, MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7680 GODDARD ST STE 216
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-8232
Mailing Address - Country:US
Mailing Address - Phone:707-338-3329
Mailing Address - Fax:970-658-1027
Practice Address - Street 1:7680 GODDARD ST STE 216
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-8232
Practice Address - Country:US
Practice Address - Phone:719-299-1626
Practice Address - Fax:970-658-1027
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0013684106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist