Active NPI
Jonathan L Fagerholm
- Addiction (Substance Use Disorder) Counselor
- Colorado Springs, CO
National Provider Identifier
1568975076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- NLC.0105760
- Practice address
- 112 Iowa Ave Ste 4
Colorado Springs, CO 80909-5947 - Phone
- (719) 358-7228
- NPI assigned
- Nov 7, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | NLC.0105760 | CO | Primary |
Addresses
Primary practice location
112 Iowa Ave Ste 4
Colorado Springs, CO 80909-5947
Mailing address
112 Iowa Ave Ste 4
Colorado Springs, CO 80909-5947
Phone (719) 358-7228
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NLC.0105760 | CO | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1510012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1510012800000",
"number": "1568975076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 IOWA AVE STE 4",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809095947",
"telephone_number": "719-358-7228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 IOWA AVE STE 4",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809095947",
"telephone_number": "719-358-7228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGERHOLM",
"first_name": "JONATHAN",
"middle_name": "L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-11-07",
"last_updated": "2017-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CO",
"license": "NLC.0105760",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.