Provider Demographics
NPI:1396323085
Name:SEIDEL, JASON A (PSYD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:SEIDEL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 S BELLAIRE ST STE 204
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4333
Mailing Address - Country:US
Mailing Address - Phone:303-547-3700
Mailing Address - Fax:
Practice Address - Street 1:8000 E PRENTICE AVE STE D12
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2759
Practice Address - Country:US
Practice Address - Phone:303-547-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2511103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical