| Fountain Valley Behavioral Health | |
|
1259 Lake Plaza Dr Ste 270 Colorado Springs CO 80906-3560 | |
| (719) 653-7776 | |
| Not Available |
| Full Name | Fountain Valley Behavioral Health |
|---|---|
| Speciality | Nurse Practitioner - Psychiatric/mental Health |
| Location | 1259 Lake Plaza Dr Ste 270, Colorado Springs, Colorado |
| Authorized Official Name and Position | Jacquita Louise Jordan (OWNER) |
| Authorized Official Contact | 7193587338 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fountain Valley Behavioral Health 1259 Lake Plaza Dr Ste 270 Colorado Springs CO 80906-3560 Ph: (719) 653-7776 | Fountain Valley Behavioral Health 1259 Lake Plaza Dr Ste 270 Colorado Springs CO 80906-3560 Ph: (719) 653-7776 |
| NPI Number | 1225890619 |
|---|---|
| Provider Enumeration Date | 01/30/2024 |
| Last Update Date | 02/09/2024 |
| Certification Date | 02/09/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225890619 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
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