Provider Demographics
NPI:1669433116
Name:JESSEN, THADEUS COLLINS (LPC)
Entity type:Individual
Prefix:MR
First Name:THADEUS
Middle Name:COLLINS
Last Name:JESSEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E HORSETOOTH RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3154
Mailing Address - Country:US
Mailing Address - Phone:970-776-6351
Mailing Address - Fax:208-567-5844
Practice Address - Street 1:300 E HORSETOOTH RD STE 200
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3154
Practice Address - Country:US
Practice Address - Phone:970-776-6351
Practice Address - Fax:208-567-5844
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3535101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health