MEDICARE: JONATHAN SARGENT

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	LPC.0016152	CO

General Provider Information

NPI Number	:	1912325739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN SARGENT

Provider Business Mailing Address
First Line	:	803 SAN BRUNO PL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	803 SAN BRUNO PL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4909
Country	:	US
Telephone Number	:	719-540-5482
Fax Number	:

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

Provider Enumeration Date	:	03/29/2014
Last Update Date	:	01/11/2023

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