Healthcare Provider Details

I. General information

NPI: 1508259664
Provider Name (Legal Business Name): BRIAN RENTON MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2015
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 IRIS AVE
BOULDER CO
80304-2226
US

IV. Provider business mailing address

1333 IRIS AVE
BOULDER CO
80304-2226
US

V. Phone/Fax

Practice location:
  • Phone: 303-443-8500
  • Fax: 303-413-6325
Mailing address:
  • Phone: 303-443-8500
  • Fax: 303-413-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: