Healthcare Provider Details

I. General information

NPI: 1396439816
Provider Name (Legal Business Name): JESSE FISTER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 S SYCAMORE ST STE 200
LITTLETON CO
80120-1146
US

IV. Provider business mailing address

5575 S SYCAMORE ST STE 200
LITTLETON CO
80120-1146
US

V. Phone/Fax

Practice location:
  • Phone: 406-540-5950
  • Fax: 406-316-5991
Mailing address:
  • Phone: 406-540-5950
  • Fax: 406-316-5991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0006964
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: