Healthcare Provider Details

I. General information

NPI: 1528168515
Provider Name (Legal Business Name): BRUCE LUIS SANTIAGO LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 PLAZA DR STE 101
HIGHLANDS RANCH CO
80129-2379
US

IV. Provider business mailing address

PO BOX 531040
ATLANTA GA
30353-1040
US

V. Phone/Fax

Practice location:
  • Phone: 720-902-3821
  • Fax: 888-472-0401
Mailing address:
  • Phone: 720-902-3821
  • Fax: 888-472-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC0014771
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH14036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: