Doctor Name: | MR. PATRICK LEONARD JETER |
NPI Number: | 1487069357 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA |
License Number: | MA PSYCHOLOGY |
Business Practice Address: | 3450 Broadway St Boulder, CO - 803041899 |
Business Phone Number: | 3034411100 |
Business Fax Number: | 3034411286 |
Mailing Address: | 3450 Broadway St, BOULDER |
State: | CO |
Postal Code: | 803041824 |
Phone Number: | 3034411100 |
Fax Number: | 3034411286 |
NPI Enumeration Date: | 06/30/2014 |
NPI Last Update Date: | 06/30/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | MA PSYCHOLOGY |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |