Provider Demographics
NPI:1538701818
Name:BREEZLEY, JENIFER (MA)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:
Last Name:BREEZLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 EAGLE PASS
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-9410
Mailing Address - Country:US
Mailing Address - Phone:303-579-4104
Mailing Address - Fax:
Practice Address - Street 1:765 E COLLEGE DR APT 2
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5556
Practice Address - Country:US
Practice Address - Phone:970-422-3830
Practice Address - Fax:970-764-4049
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0017016101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health