Healthcare Provider Details

I. General information

NPI: 1881147015
Provider Name (Legal Business Name): SVETLANA BRUK SKORNYAKOV M.S., MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2016
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SOUTH PARKER RD BUILDING 5 SUITE 155
AURORA CO
80014
US

IV. Provider business mailing address

6760 S FULTONDALE CT
AURORA CO
80016-4133
US

V. Phone/Fax

Practice location:
  • Phone: 720-669-3962
  • Fax:
Mailing address:
  • Phone: 650-455-5940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT93502
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT0001557
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: