Provider Demographics
NPI:1376093989
Name:COLLIER, JEFFERSON D (LPC)
Entity Type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:D
Last Name:COLLIER
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 1:2500 JOHN GLENN HWY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9028
Mailing Address - Country:US
Mailing Address - Phone:740-439-4428
Mailing Address - Fax:740-588-6452
Practice Address - Street 1:2500 JOHN GLENN HWY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9028
Practice Address - Country:US
Practice Address - Phone:740-439-4428
Practice Address - Fax:740-588-6452
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1300645101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health