Provider Demographics
NPI:1699905737
Name:PRUCHA, DAVID LAWRENCE
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LAWRENCE
Last Name:PRUCHA
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 1:1590 WYNKOOP ST
Mailing Address - Street 2:APT. 313
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1168
Mailing Address - Country:US
Mailing Address - Phone:303-901-2745
Mailing Address - Fax:
Practice Address - Street 1:5500 S SYCAMORE ST
Practice Address - Street 2:SUITE 222
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8201
Practice Address - Country:US
Practice Address - Phone:303-723-4279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor