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NPI Code Detail

MEDICARE: JOHN JURICA PH.D.

MEDICARE:   JOHN  JURICA  PH.D.
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
1101Y00000XCounselor
2103TC1900XCounseling PsychologistPSY.0005453CO

General Provider Information

NPI Number : 1760854665
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN JURICA PH.D.
Provider Business Mailing Address
First Line : 3555 STANFORD RD STE 140
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-4680
Country : US
Telephone Number : 970-235-1159
Fax Number :
Provider Business Practice Location Address
First Line : 3555 STANFORD RD STE 140
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-4680
Country : US
Telephone Number : 970-305-3175
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2015
Last Update Date : 07/05/2025

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