Provider Demographics
NPI:1063804086
Name:MOLLENKAMP, ROGER (CO LPC)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:MOLLENKAMP
Suffix:
Gender:
Credentials:CO LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 SWOPE AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5837
Mailing Address - Country:US
Mailing Address - Phone:719-330-7073
Mailing Address - Fax:719-635-0213
Practice Address - Street 1:328 SWOPE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5837
Practice Address - Country:US
Practice Address - Phone:719-330-7073
Practice Address - Fax:719-635-0213
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2726101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional