Healthcare Provider Details

I. General information

NPI: 1649094863
Provider Name (Legal Business Name): BREE MARK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 S BISCAY WAY
AURORA CO
80017-4440
US

IV. Provider business mailing address

1500 N GRANT ST STE C
DENVER CO
80203-1859
US

V. Phone/Fax

Practice location:
  • Phone: 303-518-4803
  • Fax:
Mailing address:
  • Phone: 303-518-4803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0024401
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0024401
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: