Healthcare Provider Details

I. General information

NPI: 1366141103
Provider Name (Legal Business Name): JOHN TZANOS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 S JACKSON ST STE 901-7
DENVER CO
80210-3808
US

IV. Provider business mailing address

1776 S JACKSON ST STE 901-7
DENVER CO
80210-3808
US

V. Phone/Fax

Practice location:
  • Phone: 720-331-9754
  • Fax:
Mailing address:
  • Phone: 720-331-9754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0005979
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: