John William Szudera, LMFT, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LCPC-5584 Issued in ID

Practice address

80 Garden Ctr Ste 252
Broomfield, CO 80020-1735

Phone

(720) 706-7508

Fax

(208) 502-2538

NPI assigned

Sep 6, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Canopy Behavioral Health, PLLC

  • Professional Counselor
  • Meridian, ID
  • NPI 1861962698
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727308800000",
    "number": "1457632218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "773 DEXTER DR",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800201509",
            "telephone_number": "208-273-9521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 GARDEN CTR STE 252",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800201735",
            "telephone_number": "720-706-7508",
            "fax_number": "208-502-2538"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "750 W Ustick Rd Ste 120",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836466133",
            "country_code": "US",
            "telephone_number": "208-273-9521",
            "fax_number": "208-502-2538",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SZUDERA",
        "first_name": "JOHN",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "LMFT, LCPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-06",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ID",
            "license": "LCPC-5584",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CO",
            "license": "MFT.0002364",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "LPC.0019370",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MT",
            "license": "BBH-LMFT-LIC-48138",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "ID",
            "license": "LMFT-5534",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admin@canopybehavioralhealth.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "750 W Ustick Rd Ste 120",
            "city": "Meridian",
            "state": "ID",
            "country_code": "US",
            "postal_code": "836466133",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Summit Medical Care, LLC
• Sunbright Behavioral Solutions LLC
• Susan G. Cole, DC, LLC
• Susanne Liebman, LLC
• John R Suyak Jr., D.C.
• Olivia Tabor
• Katherine Tackett, N.D.
• Take Care Health Colorado, Inc.
• Brittany Talbot, COTA/L
• Leslie Tamayo

• Professional Counselor in Broomfield, CO
• Providers in Broomfield, CO by specialty
• Professional Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.