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General NPI Number Information
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NPI Number | 1710378146
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Entity Type | Individual
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Provider Name | JONATHAN GARDINER LEARS MA, LPC
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Gender | Male
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Dates
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Enumeration Date | 02/06/2015
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Last Update Date | 02/06/2015
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Provider Practice Location Address
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Address Line | 5600 ARAPAHOE AVE SUITE 102
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City | BOULDER
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State | CO
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Zip | 80303
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Country | US
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Telephone | 303-507-7510
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 960 369 W SPRING ST
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City | NEDERLAND
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State | CO
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Zip | 80466-0960
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Country | US
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Telephone | 303-507-7510
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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.0011606
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License Number State | CO
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