Provider Demographics
NPI:1396278024
Name:REZNICEK-PARRADO, JEFFREY (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:REZNICEK-PARRADO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:REZNICEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:950 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4717
Mailing Address - Country:US
Mailing Address - Phone:530-746-8319
Mailing Address - Fax:
Practice Address - Street 1:950 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4717
Practice Address - Country:US
Practice Address - Phone:530-746-8319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY4818103TC1900X
CAPSY27790103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling