Provider Demographics
NPI:1417984253
Name:EMRICK, CHAD DUANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:DUANE
Last Name:EMRICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 472635
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80047-2635
Mailing Address - Country:US
Mailing Address - Phone:303-290-0575
Mailing Address - Fax:303-393-5272
Practice Address - Street 1:950 S CHERRY ST STE 424
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-2612
Practice Address - Country:US
Practice Address - Phone:303-507-5035
Practice Address - Fax:303-393-4603
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO414103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO92436Medicare ID - Type UnspecifiedPSYCHOLOGIST