Provider Demographics
NPI:1366751596
Name:SMITH, JON C
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 E DRY CREEK RD
Mailing Address - Street 2:SUITE E-207
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2537
Mailing Address - Country:US
Mailing Address - Phone:303-660-5397
Mailing Address - Fax:
Practice Address - Street 1:7200 E DRY CREEK RD
Practice Address - Street 2:SUITE E-207
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2537
Practice Address - Country:US
Practice Address - Phone:303-660-5397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0012608101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional