Provider Demographics
NPI:1275169625
Name:FARMER, JEFFREY D (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:FARMER
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 FORDHAM CIR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-1648
Mailing Address - Country:US
Mailing Address - Phone:970-402-1868
Mailing Address - Fax:
Practice Address - Street 1:319 N WEBER ST STE 1C
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1228
Practice Address - Country:US
Practice Address - Phone:719-377-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0017768101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional