Healthcare Provider Details

I. General information

NPI: 1730645235
Provider Name (Legal Business Name): TREVOR M BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 07/21/2023
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 38TH ST STE 100E
BOULDER CO
80301-2624
US

IV. Provider business mailing address

999 N PEARL ST APT 203
DENVER CO
80203-3246
US

V. Phone/Fax

Practice location:
  • Phone: 970-319-7190
  • Fax:
Mailing address:
  • Phone: 970-319-7190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0018206
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0016553
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: