Provider Demographics
NPI:1770665671
Name:WEGENER, BARBARA JEAN (LPC)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:WEGENER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 BLUE SPRUCE RD
Mailing Address - Street 2:
Mailing Address - City:DIVIDE
Mailing Address - State:CO
Mailing Address - Zip Code:80814-7701
Mailing Address - Country:US
Mailing Address - Phone:719-396-4650
Mailing Address - Fax:720-465-2275
Practice Address - Street 1:337 BLUE SPRUCE RD
Practice Address - Street 2:
Practice Address - City:DIVIDE
Practice Address - State:CO
Practice Address - Zip Code:80814-7701
Practice Address - Country:US
Practice Address - Phone:719-396-4650
Practice Address - Fax:720-465-2275
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC 4208101Y00000X
CO4208101YP2500X
FLMH 12163101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1770665671Medicaid