Healthcare Provider Details

I. General information

NPI: 1578477139
Provider Name (Legal Business Name): BRANDON GRUND MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 WADSWORTH BLVD UNIT 157
WHEAT RIDGE CO
80033-4671
US

IV. Provider business mailing address

3501 WADSWORTH BLVD UNIT 157
WHEAT RIDGE CO
80033-4671
US

V. Phone/Fax

Practice location:
  • Phone: 303-218-8295
  • Fax:
Mailing address:
  • Phone: 303-218-8295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0024382
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: