Healthcare Provider Details

I. General information

NPI: 1306174156
Provider Name (Legal Business Name): RICHARD M JACOBSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2009
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 E EMPIRE ST
CORTEZ CO
81321-2802
US

IV. Provider business mailing address

150 MERCURY VILLAGE DR
DURANGO CO
81301-8955
US

V. Phone/Fax

Practice location:
  • Phone: 970-565-7946
  • Fax: 970-565-9005
Mailing address:
  • Phone:
  • Fax: 970-335-2348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACB6993
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09923680
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: