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General NPI Number Information
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NPI Number | 1033104740
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Entity Type | Individual
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Provider Name | JOHN HAROLD JORGENSEN LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 313 N TEJON ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-1243
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Country | US
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Telephone | 719-629-6406
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Fax |
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Provider Business Mailing Address
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Address Line | 15894 KANSAS PACIFIC COURT
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City | MONUMENT
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State | CO
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Zip | 80132-2502
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Country | US
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Telephone | 719-629-6406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 991975
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License Number State | CO
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