JEFFREY DAVID DERRY LPC
NPI 1528359734
Counselor - Professional in Fountain, CO

Q: What is Jeffrey Derry's NPI number?

The NPI number for Jeffrey Derry is 1528359734. It was assigned to this individual provider in the NPPES registry on April 21, 2011.

Q: What is Jeffrey Derry's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Q: When was this NPI record last updated?

The NPPES record for Jeffrey Derry was last updated on March 21, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 21, 2011PECOS EnrolledAccepts Medicare Assignment

350 LYCKMAN PL, FOUNTAIN, CO 80817(719) 632-5700 Get Directions Write a Review

NPPES record last updated: March 21, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 21, 2018, Aug 8, 2016 (2 updates tracked since 2016).

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About Jeffrey David Derry Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JEFFREY DAVID DERRY LPC (NPI 1528359734) is an individual professional provider in Fountain, Colorado, licensed in Colorado (LPC.0003637) and active in the NPI registry since April 2011. He is enrolled in Medicare PECOS, maintains a secondary practice location in Lake Ozark, and is a graduate of Other (1999).

NPPES Registry Identity

NPI1528359734

Entity TypeIndividualMale

Primary Taxonomy101YP2500X

Provider Legal NameJEFFREY DAVID DERRYCredential: LPC

Location Address350 LYCKMAN PLFountain, CO 80817-2861

Mailing Address3205 N Academy Blvd Ste 130Colorado Springs, CO 80917-5152 · (719) 632-5700

Phone(719) 632-5700

Sole ProprietorNo

Medical School CMSOtherGraduated 1999

Enumeration DateApril 21, 2011

Last NPPES UpdateMarch 21, 20182 updates tracked since enumeration

✔ NPI 1528359734 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

License✔ Licensed in CO · LPC.0003637

Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License 2009024349 (MO)

350 LYCKMAN PL, Fountain, CO 80817

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Secondary Practice Location 1

Location 12935 Bagnell Dam BlvdLake Ozark, MO 65049-8661 · Phone (573) 202-3740 · Fax (866) 358-6406

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jeffrey David Derry Lpc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9335599307

PECOS Enrollment IDI20240103002516

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PATRICK MICHAEL CASSIDY P.A.-C

Physician Assistant