Provider Demographics
NPI:1174314074
Name:MASON, JEREMY LLOYD (MA, LPCC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:LLOYD
Last Name:MASON
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 S CAROLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-1523
Mailing Address - Country:US
Mailing Address - Phone:720-934-5078
Mailing Address - Fax:
Practice Address - Street 1:2975 VALMONT RD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1361
Practice Address - Country:US
Practice Address - Phone:720-934-5078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0022123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty