Provider Demographics
NPI:1194966234
Name:JEPSEN, ANNABEL H (MA)
Entity type:Individual
Prefix:
First Name:ANNABEL
Middle Name:H
Last Name:JEPSEN
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 1:26996 COUNTY ROAD 65
Mailing Address - Street 2:
Mailing Address - City:MOFFAT
Mailing Address - State:CO
Mailing Address - Zip Code:81143-9756
Mailing Address - Country:US
Mailing Address - Phone:719-580-0678
Mailing Address - Fax:
Practice Address - Street 1:26996 COUNTY ROAD 65
Practice Address - Street 2:
Practice Address - City:MOFFAT
Practice Address - State:CO
Practice Address - Zip Code:81143-9756
Practice Address - Country:US
Practice Address - Phone:719-580-0678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5105101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional