Provider Demographics
NPI:1639604234
Name:RUCKER, JAMES ANTHONY SR (MA, LAC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ANTHONY
Last Name:RUCKER
Suffix:SR
Gender:M
Credentials:MA, LAC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16423 E ADRIATIC PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-1105
Mailing Address - Country:US
Mailing Address - Phone:720-296-2467
Mailing Address - Fax:
Practice Address - Street 1:16423 E ADRIATIC PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-1105
Practice Address - Country:US
Practice Address - Phone:720-504-5585
Practice Address - Fax:720-513-0777
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0001299101YA0400X
COMFT.0002478106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000175546Medicaid