Provider Demographics
NPI:1457558561
Name:OMEROD, JEREMY A (LCPC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:A
Last Name:OMEROD
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-4721
Mailing Address - Country:US
Mailing Address - Phone:815-508-2525
Mailing Address - Fax:
Practice Address - Street 1:1819 BAY SCOTT CIR STE 109
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1130
Practice Address - Country:US
Practice Address - Phone:630-357-2456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006916101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional