Individual provider Active NPI

Jinny Mortensen, M.A., LPC

  • Professional Counselor
  • Fort Collins, CO
National Provider Identifier
1326472846
Registry record updated Oct 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC.0012377 Issued in CO
Practice address
4115 Boardwalk Dr Unit 100
Fort Collins, CO 80525-5945
Phone
(970) 493-4580
NPI assigned
Sep 3, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LPC.0012377 CO Primary

Addresses

Primary practice location

4115 Boardwalk Dr Unit 100
Fort Collins, CO 80525-5945

Mailing address

4115 Boardwalk Dr Unit 100
Fort Collins, CO 80525-5945
Phone (970) 493-4580

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
I20241203001140 CO Practitioner - Mental Health Counselor 6103271911 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4115 Boardwalk Dr
Unit 100
Fort Collins, CO 80525-5945
Phone (970) 493-4580

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LPC.0012377COMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Neurofeedback Clinic of Northern Colorado LLC Professional CurrentSince Nov 20, 2024 Accepting new patients
Neurofeedback Clinic of Northern Colorado LLC Professional CurrentSince Nov 20, 2024 Accepting new patients

Locations

4115 Boardwalk Dr
Unit 100
Fort Collins, CO 80525
Phone (970) 493-4580

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": "1378166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476230400000",
    "number": "1326472846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4115 BOARDWALK DR UNIT 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805255945",
            "telephone_number": "970-493-4580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4115 BOARDWALK DR UNIT 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805255945",
            "telephone_number": "970-493-4580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTENSEN",
        "first_name": "JINNY",
        "credential": "M.A., LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-03",
        "last_updated": "2016-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "LPC.0012377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.