Provider Demographics
NPI:1609398890
Name:READ, JESSIE R (LPC)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:R
Last Name:READ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 S DAYTON WAY APT 1101
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-3913
Mailing Address - Country:US
Mailing Address - Phone:404-502-3738
Mailing Address - Fax:
Practice Address - Street 1:2727 BRYANT ST STE 500
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-4153
Practice Address - Country:US
Practice Address - Phone:720-722-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0017974101YM0800X
COLPCC.0016507101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000203041Medicaid