Healthcare Provider Details

I. General information

NPI: 1821129230
Provider Name (Legal Business Name): JOHN H ENGEBRETSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 VESTA RD
SALIDA CO
81201-9327
US

IV. Provider business mailing address

111 VESTA RD
SALIDA CO
81201-9327
US

V. Phone/Fax

Practice location:
  • Phone: 719-275-2351
  • Fax:
Mailing address:
  • Phone: 719-275-2351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4641
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1108
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: