Provider Demographics
NPI:1013172634
Name:COLBY, JENNIFER (LMSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:COLBY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-4139
Mailing Address - Country:US
Mailing Address - Phone:785-628-2871
Mailing Address - Fax:785-628-0330
Practice Address - Street 1:208 E 7TH ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-4139
Practice Address - Country:US
Practice Address - Phone:785-628-2871
Practice Address - Fax:785-628-0330
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
KS7424104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS7424OtherLICENSE NUMBER
KS69OtherLICENSED ADDICTION COUNSELOR