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General NPI Number Information
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NPI Number | 1003687047
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Entity Type | Individual
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Provider Name | JACOB TYLER DOERING MS, LPC, NCC, CRC
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Gender | Male
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Dates
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Enumeration Date | 01/09/2024
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 327 COLORADO AVE
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City | PUEBLO
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State | CO
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Zip | 81004-2005
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Country | US
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Telephone | 719-948-7120
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Fax |
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Provider Business Mailing Address
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Address Line | 4310 SENTINEL PL
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City | PUEBLO
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State | CO
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Zip | 81008-1875
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Country | US
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Telephone | 972-768-7541
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC.0021786
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 87311
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License Number State | TX
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