Healthcare Provider Details

I. General information

NPI: 1619442068
Provider Name (Legal Business Name): JESSICA SHIFLETT MS, NCE, LPC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 PHAY AVE
CANON CITY CO
81212-2334
US

IV. Provider business mailing address

1013 MADISON ST
CANON CITY CO
81212-4154
US

V. Phone/Fax

Practice location:
  • Phone: 719-618-8797
  • Fax:
Mailing address:
  • Phone: 719-618-8797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberADC.0002318
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0017473
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: