Basic Information
| Provider Information | |||||||||
| NPI: | 1679674147 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHIPPEAUX | ||||||||
| FirstName: | JASON | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1016 W SAGINAW DR | ||||||||
| Address2: | |||||||||
| City: | PUEBLO WEST | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810077002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195317785 | ||||||||
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| Practice Location | |||||||||
| Address1: | 41 MONTEBELLO RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810011379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195452746 | ||||||||
| FaxNumber: | 7195429638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 02/16/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW.00000133 | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.