MEDICARE: BRYANA ADDISON OWENS LCSW, ACHP-SW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	1041C0700X	Clinical Social Worker	CSW-1608	CO

General Provider Information

NPI Number	:	1043575012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYANA ADDISON OWENS LCSW, ACHP-SW

Provider Business Mailing Address
First Line	:	1540 NIAGARA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-1741
Country	:	US
Telephone Number	:	720-297-6479
Fax Number	:

Provider Business Practice Location Address
First Line	:	1540 NIAGARA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-1741
Country	:	US
Telephone Number	:	720-297-6479
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2012
Last Update Date	:	07/05/2012

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