Provider Demographics
NPI:1851646137
Name:REDMAN, JESSIKA (DBH, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:JESSIKA
Middle Name:
Last Name:REDMAN
Suffix:
Gender:F
Credentials:DBH, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 PERRY ST
Mailing Address - Street 2:STE 206A
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2434
Mailing Address - Country:US
Mailing Address - Phone:303-386-6429
Mailing Address - Fax:
Practice Address - Street 1:333 PERRY ST
Practice Address - Street 2:STE 206A
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2434
Practice Address - Country:US
Practice Address - Phone:303-386-6429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0006522101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health