Provider Demographics
NPI:1811244296
Name:CYPERT, JERRY NEIL II (MED, LPC, LAC)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:NEIL
Last Name:CYPERT
Suffix:II
Gender:M
Credentials:MED, LPC, LAC
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 130
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80038-0130
Mailing Address - Country:US
Mailing Address - Phone:806-786-4460
Mailing Address - Fax:
Practice Address - Street 1:1720 S BELLAIRE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4304
Practice Address - Country:US
Practice Address - Phone:806-786-4460
Practice Address - Fax:806-786-4460
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2016-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11483101YA0400X
TX68694101YP2500X
COLPC.0012269101YP2500X
COACD.0000538101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)