Healthcare Provider Details

I. General information

NPI: 1205744596
Provider Name (Legal Business Name): BRENNA MACK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 S HARLAN ST STE 200
LAKEWOOD CO
80226-3552
US

IV. Provider business mailing address

4975 AUSTIN BLUFFS PKWY
COLORADO SPRINGS CO
80918-5043
US

V. Phone/Fax

Practice location:
  • Phone: 719-645-2551
  • Fax: 877-557-2410
Mailing address:
  • Phone: 719-645-2551
  • Fax: 877-557-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0024247
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: