Individual
JONATHAN L FAGERHOLM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
112 IOWA AVE STE 4, COLORADO SPRINGS, CO 80909-5947
(719) 358-7228
Mailing address
112 IOWA AVE STE 4, COLORADO SPRINGS, CO 80909-5947
(719) 358-7228
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
NLC.0105760
CO
Other
Enumeration date
11/07/2017
Last updated
11/07/2017
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