Provider Demographics
NPI:1093218216
Name:BLOUNT, JESSICA LYNN (LPC, LAC, NCC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:LPC, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3764 CHIA DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80925-1379
Mailing Address - Country:US
Mailing Address - Phone:719-440-6283
Mailing Address - Fax:
Practice Address - Street 1:112 IOWA AVE STE 4
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5947
Practice Address - Country:US
Practice Address - Phone:719-358-7338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0015254101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor