Jeanine Ten Broeck, LPC
Individual provider Active NPI Professional Counselor · Crestone, CO
NPI 1154585974 · NPPES record last updated Nov 20, 2024
Key facts
- NPI
- 1154585974
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 5924 (CO)
- Practice address
- 2760 N Carefree Way
Crestone, CO 80229 - Phone
- (970) 844-5570
- NPI assigned
- Jul 10, 2008
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 5924 | CO | Yes |
Addresses
Primary practice location
2760 N Carefree Way
Crestone, CO 80229
Mailing address
PO Box 631
Crestone, CO 81131-0631
Phone (970) 844-5570
Other providers in Crestone, CO
- Remy Olson
- Shawn Quick
- Refined Form Physical Therapy, PLLC
- Philip Aaron Schechter
- James Michael Sheeran
- Jennifer Elaine Walkowski
- Kathleen Marie Willow
All providers in Crestone, CO · Professional Counselor in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.