Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC.0013085 | CO |
NPI | 1003360579 |
---|---|
Provider Name | Jeremy Rogers |
First Address | Colorado Springs, CO 80907-3566 |
Second Address | Colorado Springs, CO 80907-3566 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2016 |
Last Update Date | 07/08/2020 |