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General NPI Number Information
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NPI Number | 1427179316
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Entity Type | Individual
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Provider Name | JOHN J SMRCKA PHD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 6081 S QUEBEC ST SUITE 103
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City | ENGLEWOOD
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State | CO
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Zip | 80111-4536
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Country | US
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Telephone | 303-694-0524
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Fax | 303-694-3290
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Provider Business Mailing Address
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Address Line | 6081 S QUEBEC ST SUITE 103
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City | ENGLEWOOD
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State | CO
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Zip | 80111-4536
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Country | US
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Telephone | 303-694-0524
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Fax | 303-694-3290
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 2163
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License Number State | CO
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