Healthcare Provider Details

I. General information

NPI: 1386553055
Provider Name (Legal Business Name): JASON PREZANT LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11364 W 18TH AVE
LAKEWOOD CO
80215-2706
US

IV. Provider business mailing address

11364 W 18TH AVE
LAKEWOOD CO
80215-2706
US

V. Phone/Fax

Practice location:
  • Phone: 516-524-1590
  • Fax:
Mailing address:
  • Phone: 516-524-1590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0025358
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: