=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346337276
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BONNIE M BRENNAN MA, LPC, CEDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 05/24/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 607 10TH ST STE 104
-----------------------------------------------------
City | GOLDEN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80401-1053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-663-8699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25587 CONIFER RD STE 105-115
-----------------------------------------------------
City | CONIFER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80433-9067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-663-8699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2639
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------