MEDICARE: JAMYE RICO LPC 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1790585313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMYE RICO LPC LLC

Provider Business Mailing Address
First Line	:	5585 ERINDALE DR STE 102
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-6966
Country	:	US
Telephone Number	:	719-351-7815
Fax Number	:

Provider Business Practice Location Address
First Line	:	5585 ERINDALE DR STE 102
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-6966
Country	:	US
Telephone Number	:	719-351-7815
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAMYE N RICO
Credential	:
Telephone Number	:	719-351-7815

Provider Enumeration Date	:	03/13/2025
Last Update Date	:	03/13/2025

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