Healthcare Provider Details

I. General information

NPI: 1437837093
Provider Name (Legal Business Name): INNER SPACE PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N PENNSYLVANIA ST STE 101
DENVER CO
80203-1303
US

IV. Provider business mailing address

810 DETROIT ST
DENVER CO
80206-3836
US

V. Phone/Fax

Practice location:
  • Phone: 720-527-9701
  • Fax:
Mailing address:
  • Phone: 720-257-9701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. BRANDON DOUGLAS BURELLE
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 720-257-9701