Provider Demographics
NPI:1689320491
Name:DEMOS, JEREMY (LPC, CSAC, ICS, NCC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:DEMOS
Suffix:
Gender:M
Credentials:LPC, CSAC, ICS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098-4349
Mailing Address - Country:US
Mailing Address - Phone:920-342-1280
Mailing Address - Fax:
Practice Address - Street 1:1501 COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53098-4349
Practice Address - Country:US
Practice Address - Phone:920-342-1280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16555101YA0400X
WI7896101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty