Healthcare Provider Details

I. General information

NPI: 1003687047
Provider Name (Legal Business Name): JACOB TYLER DOERING MS, LPC, NCC, CRC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 COLORADO AVE
PUEBLO CO
81004-2005
US

IV. Provider business mailing address

4310 SENTINEL PL
PUEBLO CO
81008-1875
US

V. Phone/Fax

Practice location:
  • Phone: 719-948-7120
  • Fax:
Mailing address:
  • Phone: 972-768-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0021786
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number87311
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: