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NPI Code Detail

MEDICARE: JEFFREY REZNICEK PHD

MEDICARE: JEFFREY REZNICEK PHD
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
1251S00000XCommunity/Behavioral Health Agency
2103TC1900XCounseling Psychologist

General Provider Information

NPI Number : 1881392934
Entity Type Code : Organization
Provider Name (Legal Business Name) : JEFFREY REZNICEK PHD
Provider Business Mailing Address
First Line : 950 MAGNOLIA ST
Second Line :
City : DENVER
State : CO
Zip : 80220-4717
Country : US
Telephone Number : 530-746-8319
Fax Number :
Provider Business Practice Location Address
First Line : 950 MAGNOLIA ST
Second Line :
City : DENVER
State : CO
Zip : 80220-4717
Country : US
Telephone Number : 530-746-8319
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JEFFREY REZNICEK
Credential : PHD
Telephone Number : 530-746-8319
Provider Enumeration Date : 02/17/2023
Last Update Date : 02/17/2023

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