Healthcare Provider Details

I. General information

NPI: 1407685092
Provider Name (Legal Business Name): JAMES MONGER II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 N ZEREX ST STE 104
FRASER CO
80442-5609
US

IV. Provider business mailing address

PO BOX 61
WINTER PARK CO
80482-0061
US

V. Phone/Fax

Practice location:
  • Phone: 540-820-9980
  • Fax:
Mailing address:
  • Phone: 540-820-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0022152
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: