Provider Demographics
NPI:1619442068
Name:SHIFLETT, JESSICA (MS, NCE, LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SHIFLETT
Suffix:
Gender:F
Credentials:MS, NCE, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 PHAY AVE
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-2334
Mailing Address - Country:US
Mailing Address - Phone:719-371-8106
Mailing Address - Fax:719-458-1080
Practice Address - Street 1:1335 PHAY AVE
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2334
Practice Address - Country:US
Practice Address - Phone:719-371-8106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0017473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty