MEDICARE: JENNIFER STEPHENSON M.A.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACD.0000829	CO
2	101YP2500X	Professional Counselor	LPC.0011827	CO

General Provider Information

NPI Number	:	1699050088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER STEPHENSON M.A.

Provider Business Mailing Address
First Line	:	2850 MCCLELLAND DR STE 3000M
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5206
Country	:	US
Telephone Number	:	970-632-3332
Fax Number	:	970-449-7404

Provider Business Practice Location Address
First Line	:	2850 MCCLELLAND DR STE 3000M
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5206
Country	:	US
Telephone Number	:	970-632-3332
Fax Number	:	970-449-7404

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

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	12/23/2019

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