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General NPI Number Information
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NPI Number | 1134441520
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Entity Type | Individual
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Provider Name | JASON DEAN DAGG BA, CAC III
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Gender | Male
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Dates
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Enumeration Date | 02/25/2010
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Last Update Date | 07/13/2016
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Provider Practice Location Address
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Address Line | 1826 E PLATTE AVE STE 223
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-5738
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Country | US
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Telephone | 719-510-2979
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Fax |
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Provider Business Mailing Address
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Address Line | 1826 E PLATTE AVE STE 223
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-5738
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Country | US
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Telephone | 719-510-2979
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ACC.0020810
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License Number State | CO
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