Provider Demographics
NPI:1457972028
Name:SEIDEL, JODI ELLEN (MA, LPC)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:ELLEN
Last Name:SEIDEL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 WESTGATE AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-7514
Mailing Address - Country:US
Mailing Address - Phone:636-484-3472
Mailing Address - Fax:
Practice Address - Street 1:5445 DTC PKWY PH 4
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3059
Practice Address - Country:US
Practice Address - Phone:636-484-3472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013652101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional