Healthcare Provider Details

I. General information

NPI: 1497692925
Provider Name (Legal Business Name): BRIANNE IRELAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S 9TH ST
CANON CITY CO
81212-3800
US

IV. Provider business mailing address

6350 BLACK RIDGE VW APT 205
COLORADO SPRINGS CO
80924-4428
US

V. Phone/Fax

Practice location:
  • Phone: 719-430-5292
  • Fax:
Mailing address:
  • Phone: 719-420-1070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: