Healthcare Provider Details

I. General information

NPI: 1871137117
Provider Name (Legal Business Name): RUBEN DAVID BERMEA JR. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 S HAVANA ST APT 334
ENGLEWOOD CO
80111-5647
US

IV. Provider business mailing address

1500 N GRANT ST # 4182
DENVER CO
80203-1859
US

V. Phone/Fax

Practice location:
  • Phone: 720-458-9346
  • Fax:
Mailing address:
  • Phone: 254-462-5401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number77051
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0018956
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0018956
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number77051
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: