Provider Demographics
NPI:1427179316
Name:SMRCKA, JOHN J (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:SMRCKA
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 1:6081 S QUEBEC ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4536
Mailing Address - Country:US
Mailing Address - Phone:303-694-0524
Mailing Address - Fax:303-694-3290
Practice Address - Street 1:6081 S QUEBEC ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80111-4536
Practice Address - Country:US
Practice Address - Phone:303-694-0524
Practice Address - Fax:303-694-3290
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY 2163103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41501063Medicaid