Provider Demographics
NPI:1851089569
Name:JESSUP, KERRY (LPC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:JESSUP
Suffix:
Gender:F
Credentials:LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 N PEARL ST APT 903
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-1664
Mailing Address - Country:US
Mailing Address - Phone:574-360-1741
Mailing Address - Fax:
Practice Address - Street 1:3455 RINGSBY CT STE 140
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-5050
Practice Address - Country:US
Practice Address - Phone:720-460-9084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0016185101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor