Provider Demographics
NPI:1790452779
Name:PFISTER, JAYSON J
Entity Type:Individual
Prefix:
First Name:JAYSON
Middle Name:J
Last Name:PFISTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2256 PARK CENTRE DR # 5-110
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-5620
Mailing Address - Country:US
Mailing Address - Phone:608-445-7243
Mailing Address - Fax:
Practice Address - Street 1:2833 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3544
Practice Address - Country:US
Practice Address - Phone:303-449-2217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)