Provider Demographics
NPI:1962376558
Name:TIDRICK, JEFFREY (LPCC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:TIDRICK
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57807 KIOWA RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81403-8194
Mailing Address - Country:US
Mailing Address - Phone:970-709-7066
Mailing Address - Fax:970-585-7868
Practice Address - Street 1:1075 SHERMAN ST STE 200
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:CO
Practice Address - Zip Code:81432-7704
Practice Address - Country:US
Practice Address - Phone:970-709-7066
Practice Address - Fax:970-585-7868
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0023768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health