Provider Demographics
NPI:1003360579
Name:ROGERS, JEREMY (LPC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:ROGERS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4570 HILTON PKWY STE 202D
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-3566
Mailing Address - Country:US
Mailing Address - Phone:719-432-9222
Mailing Address - Fax:719-960-2894
Practice Address - Street 1:4570 HILTON PKWY STE 202D
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3566
Practice Address - Country:US
Practice Address - Phone:719-432-9222
Practice Address - Fax:719-960-2894
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0013085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional