Provider Demographics
NPI:1376389700
Name:LANDERS, JENNIFER (LPCC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:LANDERS
Suffix:
Gender:F
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:PO BOX 62057
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80962-2057
Mailing Address - Country:US
Mailing Address - Phone:719-373-1107
Mailing Address - Fax:
Practice Address - Street 1:430 BEACON LITE RD UNIT 125
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9182
Practice Address - Country:US
Practice Address - Phone:626-650-7298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-04
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0022071101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional