1710378146 NPI number — MR. JONATHAN GARDINER LEARS MA, LPC

Table of content: MR. JONATHAN GARDINER LEARS MA, LPC (NPI 1710378146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710378146 NPI number — MR. JONATHAN GARDINER LEARS MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEARS
Provider First Name:
JONATHAN
Provider Middle Name:
GARDINER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710378146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 960
Provider Second Line Business Mailing Address:
369 W SPRING ST
Provider Business Mailing Address City Name:
NEDERLAND
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80466-0960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-507-7510
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5600 ARAPAHOE AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BOULDER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-507-7510
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC.0011606 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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