Provider Demographics
NPI:1245324763
Name:ROTTINI, JEREMY (LPC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:ROTTINI
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5401 W 20TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3002
Practice Address - Country:US
Practice Address - Phone:970-829-2498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2025-05-05
Deactivation Date:2018-02-13
Deactivation Code:
Reactivation Date:2025-05-05
Provider Licenses
StateLicense IDTaxonomies
CO3962101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3962OtherLPC