Individual provider Active NPI

Jessica Kahanaoi, MA

  • Professional Counselor
  • Wheat Ridge, CO
National Provider Identifier
1053860775
Registry record updated Feb 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC.0015758 Issued in CO
Practice address
4851 Independence St
Wheat Ridge, CO 80033-6715
Phone
(720) 512-1687
NPI assigned
Sep 22, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X ACD.0001126 CO
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X LPC.0015758 CO Primary

Addresses

Primary practice location

4851 Independence St
Wheat Ridge, CO 80033-6715

Mailing address

4851 Independence St
Wheat Ridge, CO 80033-6715
Phone (303) 432-5234

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240624000236 CO Practitioner - Mental Health Counselor 1254874969 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson Center for Mental HealthGroup PAC ID 9032018882, 97 clinicians

Practice addresses (Care Compare)

4851 Independence St
Suite 100
Wheat Ridge, CO 80033-6711
Phone (303) 425-0300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
ACD.0001126COMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson Center for Mental Health Mental Health CurrentSince Apr 6, 2024 Accepting new patients
Jefferson Center for Mental Health CurrentSince Apr 6, 2024 Accepting new patients

Locations

16280 W 64th Ave
Arvada, CO 80007
Phone (720) 898-1110

4851 Independence St
Wheat Ridge, CO 80033
Phone (303) 432-5115

4851 Independence St
Ste 100
Wheat Ridge, CO 80033
Phone (303) 456-5495

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739750400000",
    "number": "1053860775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4851 INDEPENDENCE ST",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800336715",
            "telephone_number": "303-432-5234",
            "fax_number": "303-432-5071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4851 INDEPENDENCE ST",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800336715",
            "telephone_number": "720-512-1687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAHANAOI",
        "first_name": "JESSICA",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-22",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CO",
            "license": "ACD.0001126",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "LPC.0015758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheat Ridge, CO

Sources for this page

Verify at the official NPI Registry.