Healthcare Provider Details

I. General information

NPI: 1558523662
Provider Name (Legal Business Name): BRENDA LEE YANG RN, MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRENDA LEE RAMER RN, MA, LPC

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 ARAPHAHOE AVE. #205
BOULDER CO
80303
US

IV. Provider business mailing address

4410 ARAPHAHOE AVE. #205
BOULDER CO
80303
US

V. Phone/Fax

Practice location:
  • Phone: 720-530-9958
  • Fax: 303-546-0047
Mailing address:
  • Phone: 720-530-9958
  • Fax: 303-546-0047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1698
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: