Provider Demographics
NPI:1457632218
Name:SZUDERA, JOHN WILLIAM (LMFT, LCPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WILLIAM
Last Name:SZUDERA
Suffix:
Gender:M
Credentials:LMFT, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 DEXTER DR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1509
Mailing Address - Country:US
Mailing Address - Phone:208-273-9521
Mailing Address - Fax:
Practice Address - Street 1:750 W USTICK RD STE 120
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6133
Practice Address - Country:US
Practice Address - Phone:208-273-9521
Practice Address - Fax:208-502-2538
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0019370101YP2500X
MTBBH-LMFT-LIC-48138106H00000X
COMFT.0002364106H00000X
IDLMFT-5534106H00000X
IDLCPC-5584101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty