Basic Information
Provider Information | |||||||||
NPI: | 1114360419 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MORSE | ||||||||
FirstName: | JESSICA | ||||||||
MiddleName: | LAUREN | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSED | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WEIGEL | ||||||||
OtherFirstName: | JESSICA | ||||||||
OtherMiddleName: | LAUREN | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 515 28 3/4 RD | ||||||||
Address2: | BLDG A | ||||||||
City: | GRAND JUNCTION | ||||||||
State: | CO | ||||||||
PostalCode: | 815015016 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9706837107 | ||||||||
FaxNumber: | 9706837167 | ||||||||
Practice Location | |||||||||
Address1: | 1023 COUNTY ROAD 610 | ||||||||
Address2: |   | ||||||||
City: | GRANBY | ||||||||
State: | CO | ||||||||
PostalCode: | 80446 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9708872179 | ||||||||
FaxNumber: | 9708879311 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/17/2013 | ||||||||
LastUpdateDate: | 04/17/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X |   |   | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.