Healthcare Provider Details

I. General information

NPI: 1760854665
Provider Name (Legal Business Name): JOHN JURICA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 STANFORD RD STE 140
FORT COLLINS CO
80525-4680
US

IV. Provider business mailing address

3555 STANFORD RD STE 140
FORT COLLINS CO
80525-4680
US

V. Phone/Fax

Practice location:
  • Phone: 970-235-1159
  • Fax:
Mailing address:
  • Phone: 970-235-1159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY.0005453
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number023198
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: