MEDICARE: BRIAN JAMES BAUER

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	101YM0800X	Mental Health Counselor	ACC.0021048	CO

General Provider Information

NPI Number	:	1346918893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN JAMES BAUER

Provider Business Mailing Address
First Line	:	2221 STACY DR
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80221-4637
Country	:	US
Telephone Number	:	720-255-5458
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 STACY DR
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80221-4637
Country	:	US
Telephone Number	:	720-255-5458
Fax Number	:

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

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	08/31/2021

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