Provider Demographics
NPI:1871286740
Name:LURIE, IAN MICHAEL
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:MICHAEL
Last Name:LURIE
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 1:397 RIDGES BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-4617
Mailing Address - Country:US
Mailing Address - Phone:970-317-7175
Mailing Address - Fax:
Practice Address - Street 1:397 RIDGES BLVD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81507-4617
Practice Address - Country:US
Practice Address - Phone:970-317-7175
Practice Address - Fax:970-360-5542
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician