Provider Demographics
NPI:1053087304
Name:CHENEY, JASON (LPC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:CHENEY
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 1:372 N BOOKCLIFF CT
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-3179
Mailing Address - Country:US
Mailing Address - Phone:970-462-9944
Mailing Address - Fax:
Practice Address - Street 1:2520 W PINYON AVE
Practice Address - Street 2:
Practice Address - City:GRAND JCT
Practice Address - State:CO
Practice Address - Zip Code:81505-6913
Practice Address - Country:US
Practice Address - Phone:970-462-9944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0017467101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional