MEDICARE: JAMIE J HENRY MS, 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	101YP2500X	Professional Counselor	16593	CO
2	101YM0800X	Mental Health Counselor	1875	WY

General Provider Information

NPI Number	:	1710465588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE J HENRY MS, LPC

Provider Business Mailing Address
First Line	:	1002 EMIGH ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4009
Country	:	US
Telephone Number	:	970-234-9135
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 EMIGH ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4009
Country	:	US
Telephone Number	:	970-234-9135
Fax Number	:

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

Provider Enumeration Date	:	08/02/2018
Last Update Date	:	05/28/2026

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