MEDICARE: JARS OF CLAY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1013563154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JARS OF CLAY, LLC

Provider Business Mailing Address
First Line	:	7875 MORNING DEW RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-5637
Country	:	US
Telephone Number	:	281-203-1514
Fax Number	:

Provider Business Practice Location Address
First Line	:	6537 N. ACADEMY
Second Line	:	1052
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-8091
Country	:	US
Telephone Number	:	303-900-8712
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MONIQUE PHILLIP
Credential	:	LPC
Telephone Number	:	303-900-8712

Provider Enumeration Date	:	08/14/2019
Last Update Date	:	08/14/2019

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