Provider Demographics
NPI:1356586721
Name:HOLCOMB, JENNIFER CAMILLE (PHD, LMFT, LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CAMILLE
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:PHD, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 DOMINION WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1464
Mailing Address - Country:US
Mailing Address - Phone:970-372-7191
Mailing Address - Fax:
Practice Address - Street 1:1935 DOMINION WAY STE 101
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1464
Practice Address - Country:US
Practice Address - Phone:970-372-7191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61855101YM0800X
TX201061106H00000X
CO969106H00000X
CO6444101YP2500X
CO1-16-22431103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst