Provider Demographics
NPI:1346537610
Name:REICHERT, JEREMY DUANE
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:DUANE
Last Name:REICHERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4395 S INDEPENDENCE CT
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-1175
Mailing Address - Country:US
Mailing Address - Phone:720-318-5833
Mailing Address - Fax:
Practice Address - Street 1:4395 S INDEPENDENCE CT
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-1175
Practice Address - Country:US
Practice Address - Phone:720-318-5833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health