Healthcare Provider Details

I. General information

NPI: 1205356664
Provider Name (Legal Business Name): BROOKE GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE KENNELL

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N GRANT ST STE R
DENVER CO
80203-1747
US

IV. Provider business mailing address

834F S PERRY ST # 1206
CASTLE ROCK CO
80104-1936
US

V. Phone/Fax

Practice location:
  • Phone: 720-791-0309
  • Fax:
Mailing address:
  • Phone: 720-791-0903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0016885
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: