Provider Demographics
NPI:1235679770
Name:BUNDRICK, JOHN (LPC, NCGC-II)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BUNDRICK
Suffix:
Gender:M
Credentials:LPC, NCGC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 S CHERRY ST STE 204
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-5037
Mailing Address - Country:US
Mailing Address - Phone:720-501-3614
Mailing Address - Fax:720-501-3614
Practice Address - Street 1:2100 S CHERRY ST STE 204
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5037
Practice Address - Country:US
Practice Address - Phone:720-501-3614
Practice Address - Fax:720-501-3614
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013499101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)