Provider Demographics
NPI:1811241524
Name:ESCOBEDO, JUAN MANUEL JR (MA)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:MANUEL
Last Name:ESCOBEDO
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
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Mailing Address - Street 1:4851 INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6715
Mailing Address - Country:US
Mailing Address - Phone:303-425-0300
Mailing Address - Fax:303-432-5018
Practice Address - Street 1:11059 E BETHANY DR
Practice Address - Street 2:STE 200
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2622
Practice Address - Country:US
Practice Address - Phone:303-617-2300
Practice Address - Fax:303-617-2397
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO13695101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health