Provider Demographics
NPI:1942325170
Name:JENNINGS, MELISSA MARIS FOUNTAIN (MA MCJ LPC LAC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MARIS FOUNTAIN
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MA MCJ LPC LAC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MARIS
Other - Last Name:FOUNTAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:992 S. 4TH AVE.
Mailing Address - Street 2:SUITE 100, #149
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601
Mailing Address - Country:US
Mailing Address - Phone:720-355-4082
Mailing Address - Fax:720-302-2671
Practice Address - Street 1:806 S PUBLIC RD STE 101
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2198
Practice Address - Country:US
Practice Address - Phone:720-335-4082
Practice Address - Fax:720-302-2671
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD844101YA0400X
COLPC4125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
84707089Medicare UPIN