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NPI Code Detail

MEDICARE: MARK GREBENER, LLC

MEDICARE: MARK GREBENER, LLC
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLAC127CO
21041C0700XClinical Social WorkerCSW434CO
31041C0700XClinical Social WorkerIL

General Provider Information

NPI Number : 1063697738
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARK GREBENER, LLC
Provider Business Mailing Address
First Line : 1418 E IRWIN LN
Second Line :
City : CENTENNIAL
State : CO
Zip : 80122-3081
Country : US
Telephone Number : 303-883-4808
Fax Number : 303-794-6736
Provider Business Practice Location Address
First Line : 7900 E UNION AVE
Second Line : SUITE 1100
City : DENVER
State : CO
Zip : 80237-2735
Country : US
Telephone Number : 303-883-4808
Fax Number : 303-794-6736
Authorized Official
Title or Position : PRINCIPAL
Name : MARK GREBENER
Credential : LCSW, LAC
Telephone Number : 303-883-4808
Provider Enumeration Date : 12/31/2007
Last Update Date : 12/31/2007

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