Healthcare Provider Details

I. General information

NPI: 1356267439
Provider Name (Legal Business Name): COLLIN RUCKER LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 BRYANT ST STE 430
DENVER CO
80211-4153
US

IV. Provider business mailing address

3188 W VIRGINIA AVE
DENVER CO
80219-2863
US

V. Phone/Fax

Practice location:
  • Phone: 970-528-4725
  • Fax:
Mailing address:
  • Phone: 970-528-4725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0024691
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: