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General NPI Number Information
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NPI Number | 1174451876
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Entity Type | Organization
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Legal Business Name | EXPANSIVE SELF PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 05/12/2026
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Last Update Date | 05/12/2026
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Provider Practice Location Address
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Address Line | 915A 11TH ST
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City | GOLDEN
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State | CO
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Zip | 80401-1105
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Country | US
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Telephone | 720-575-0977
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Fax |
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Provider Business Mailing Address
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Address Line | 619 12TH ST # 523
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City | GOLDEN
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State | CO
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Zip | 80401-1108
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Country | US
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Telephone | 720-575-0977
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Fax | 720-815-0258
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Authorized Official
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Title or Position | OWNER, THERAPIST
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Name | CAMILLE BRUNEL
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Credential | LPC
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Telephone | 720-575-0977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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