MEDICARE: JEFFREY L MOWERY LPC

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	101Y00000X	Counselor	0013963	CO
2	101Y00000X	Counselor
3	101YP2500X	Professional Counselor	0013963	CO

General Provider Information

NPI Number	:	1043560402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY L MOWERY LPC

Provider Business Mailing Address
First Line	:	1802 CHAPEL HILLS DR.
Second Line	:	SUITE A
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920
Country	:	US
Telephone Number	:	719-433-1407
Fax Number	:	918-485-0204

Provider Business Practice Location Address
First Line	:	1802 CHAPEL HILLS DR STE A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3736
Country	:	US
Telephone Number	:	719-433-1407
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	03/17/2018

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