Provider Demographics
NPI:1134441520
Name:DAGG, JASON DEAN (BA, CAC III)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:DEAN
Last Name:DAGG
Suffix:
Gender:M
Credentials:BA, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 E PLATTE AVE STE 223
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5738
Mailing Address - Country:US
Mailing Address - Phone:719-510-2979
Mailing Address - Fax:
Practice Address - Street 1:1826 E PLATTE AVE STE 223
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5738
Practice Address - Country:US
Practice Address - Phone:719-510-2979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0020810101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
COACC.0020810OtherADDICTION COUNSELOR CERTIFICATION COLORADO DEPARTMENT OF REGULATORY AGENCIES