Healthcare Provider Details

I. General information

NPI: 1932034402
Provider Name (Legal Business Name): JORDAN JENNINGS LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

867 JENNY LN
BERTHOUD CO
80513-7013
US

IV. Provider business mailing address

867 JENNY LN
BERTHOUD CO
80513-7013
US

V. Phone/Fax

Practice location:
  • Phone: 309-716-0531
  • Fax:
Mailing address:
  • Phone: 309-716-0531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0023849
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: