Healthcare Provider Details

I. General information

NPI: 1518861574
Provider Name (Legal Business Name): KELLAN MICHAEL ROYBAL LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 E EGBERT ST STE 200
BRIGHTON CO
80601-2484
US

IV. Provider business mailing address

1870 W 122ND AVE
WESTMINSTER CO
80234-2024
US

V. Phone/Fax

Practice location:
  • Phone: 303-853-3500
  • Fax:
Mailing address:
  • Phone: 303-853-3715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLSW.0009927615
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: