Individual
JEFFREY DAVID DERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
350 LYCKMAN PL, FOUNTAIN, CO 80817-2861
(719) 632-5700
Mailing address
3205 N ACADEMY BLVD STE 130, COLORADO SPRINGS, CO 80917-5152
(719) 632-5700
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
2009024349
MO
101YP2500X
Professional Counselor
Primary
LPC.0003637
CO
Other
Enumeration date
04/21/2011
Last updated
03/21/2018
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