Provider Demographics
NPI:1336521434
Name:MYERSON, JEROME (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:MYERSON
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 1:1501 YARMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-0564
Mailing Address - Country:US
Mailing Address - Phone:303-786-9314
Mailing Address - Fax:720-554-8043
Practice Address - Street 1:7985 VANCE DR STE 105
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-2120
Practice Address - Country:US
Practice Address - Phone:720-288-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0013397101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000177434Medicaid