Active NPI
Jeanne Marie Wickham, LPC, LAC
- Mental Health Counselor
- Colorado Springs, CO
National Provider Identifier
1265940696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LPC.0017285
- Practice address
- 3225 Templeton Gap Rd Ste 111
Colorado Springs, CO 80907-8729 - Phone
- (719) 351-9656
- NPI assigned
- Jan 19, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | ACD.0001464 | CO | |
| Mental Health Counselor | 101YM0800X | LPC.0017285 | CO | Primary |
Addresses
Primary practice location
3225 Templeton Gap Rd Ste 111
Colorado Springs, CO 80907-8729
Mailing address
3225 Templeton Gap Rd Ste 111
Colorado Springs, CO 80907-8729
Phone (719) 351-9656
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 19, 2024 through Mar 19, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ACD.0001464 | CO | MD | Addiction (Substance Use Disorder) Counselor |
| LPC.0017285 | CO | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742169600000",
"number": "1265940696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3225 TEMPLETON GAP RD STE 111",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809078729",
"telephone_number": "719-351-9656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3225 TEMPLETON GAP RD STE 111",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809078729",
"telephone_number": "719-351-9656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKHAM",
"first_name": "JEANNE",
"middle_name": "MARIE",
"credential": "LPC, LAC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-01-19",
"last_updated": "2025-03-17",
"certification_date": "2025-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CO",
"license": "ACD.0001464",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CO",
"license": "LPC.0017285",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.