Healthcare Provider Details

I. General information

NPI: 1740769116
Provider Name (Legal Business Name): JMK COUNSELING SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CORONADO CT BLDG 7
FORT COLLINS CO
80525-4929
US

IV. Provider business mailing address

109 CORONADO CT BLDG 7
FORT COLLINS CO
80525-4929
US

V. Phone/Fax

Practice location:
  • Phone: 970-658-0362
  • Fax:
Mailing address:
  • Phone: 970-658-0362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT.0001349
License Number StateCO

VIII. Authorized Official

Name: JESSICA KUHN
Title or Position: LMFT / PRESIDENT
Credential: MA, LMFT
Phone: 970-658-0362