Provider Demographics
NPI:1487696308
Name:MCINROY, JOHN (JACK) D (EDD)
Entity type:Individual
Prefix:DR
First Name:JOHN (JACK)
Middle Name:D
Last Name:MCINROY
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7555 E. HAMPDEN AVE #535
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4836
Mailing Address - Country:US
Mailing Address - Phone:303-929-2598
Mailing Address - Fax:720-535-1934
Practice Address - Street 1:7555 E. HAMPDEN AVE #535
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4836
Practice Address - Country:US
Practice Address - Phone:303-929-2598
Practice Address - Fax:720-535-1934
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO518103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical