MEDICARE: JESSICA ANNE MORTENSEN BA, MA, LPC, CAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	07010014056	VA
2	101YP2500X	Professional Counselor	LPC.0017088	CO

General Provider Information

NPI Number	:	1356688683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ANNE MORTENSEN BA, MA, LPC, CAS

Provider Business Mailing Address
First Line	:	1500 N GRANT ST STE R
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1859
Country	:	US
Telephone Number	:	720-295-9893
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 N GRANT ST STE R
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1859
Country	:	US
Telephone Number	:	720-295-9893
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	02/20/2026

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