Provider Demographics
NPI:1013461482
Name:JARZOMBEK, GRIFFIN (CAC II)
Entity Type:Individual
Prefix:
First Name:GRIFFIN
Middle Name:
Last Name:JARZOMBEK
Suffix:
Gender:M
Credentials:CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HORIZON DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:COLORADO
Mailing Address - Zip Code:81611
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 CASTLE CREEK RD
Practice Address - Street 2:STE 9
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-3125
Practice Address - Country:US
Practice Address - Phone:970-920-5555
Practice Address - Fax:970-920-5557
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB.0008067101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)