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General NPI Number Information
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NPI Number | 1114408770
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Entity Type | Organization
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Legal Business Name | BRAVING DOULA COLLECTIVE LLC
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 10699 W 9TH PL
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City | LAKEWOOD
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State | CO
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Zip | 80215-5621
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Country | US
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Telephone | 720-435-4522
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Fax |
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Provider Business Mailing Address
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Address Line | 10699 W 9TH PL
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City | LAKEWOOD
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State | CO
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Zip | 80215-5621
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MAC BRYDUM
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Credential | MSW, CD/CBE (DTI)
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Telephone | 720-435-4522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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