Provider Demographics
NPI:1487069357
Name:JETER, PATRICK LEONARD (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:LEONARD
Last Name:JETER
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 CAMEL DRIVERS LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-1101
Mailing Address - Country:US
Mailing Address - Phone:719-331-0716
Mailing Address - Fax:
Practice Address - Street 1:1560 CAMEL DRIVERS LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-1101
Practice Address - Country:US
Practice Address - Phone:719-331-0716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMA PSYCHOLOGY101Y00000X
COLPC.0014382101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor