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General NPI Number Information
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NPI Number | 1942764576
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Entity Type | Individual
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Provider Name | JOHN DAVID ISAACS
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Gender | Male
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Dates
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Enumeration Date | 01/28/2019
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Last Update Date | 01/28/2019
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Provider Practice Location Address
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Address Line | 2708 PATTERSON RD
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City | GRAND JUNCTION
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State | CO
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Zip | 81506-4031
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Country | US
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Telephone | 970-618-4368
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Fax |
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Provider Business Mailing Address
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Address Line | 189 S 3RD ST
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City | CARBONDALE
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State | CO
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Zip | 81623-2005
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Country | US
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Telephone | 970-618-4368
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC.0013998
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License Number State | CO
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