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General NPI Number Information
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NPI Number | 1205581964
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Entity Type | Organization
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Legal Business Name | BRAINREVIVE PSYCHIATRY
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Dates
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Enumeration Date | 02/21/2022
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Last Update Date | 02/21/2022
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Provider Practice Location Address
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Address Line | 4465 S FOX ST
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City | ENGLEWOOD
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State | CO
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Zip | 80110-5618
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Country | US
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Telephone | 720-316-7884
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Fax |
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Provider Business Mailing Address
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Address Line | 3531 S LOGAN ST STE D
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City | ENGLEWOOD
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State | CO
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Zip | 80113-3700
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Country | US
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Telephone | 720-316-7884
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Fax | 303-362-6226
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Authorized Official
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Title or Position | PMHNP
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Name | MS. ALISON SUZANNE BURTON
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Credential | PMHNP
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Telephone | 720-316-7884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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