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General NPI Number Information
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NPI Number | 1194175539
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Entity Type | Individual
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Provider Name | BRANDON RAY LLOYD
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Gender | Male
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 12/27/2018
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Provider Practice Location Address
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Address Line | 245 S ACADEMY BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-2713
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Country | US
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Telephone | 605-271-2690
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Fax | 605-271-3956
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Provider Business Mailing Address
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Address Line | 167 GRINNELL ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80911-2219
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Country | US
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Telephone | 719-210-8280
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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