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General NPI Number Information
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NPI Number | 1437837093
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Entity Type | Organization
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Legal Business Name | INNER SPACE PSYCHIATRY PLLC
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Dates
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Enumeration Date | 07/05/2023
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 1600 N PENNSYLVANIA ST STE 101
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City | DENVER
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State | CO
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Zip | 80203-1303
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Country | US
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Telephone | 720-527-9701
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Fax |
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Provider Business Mailing Address
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Address Line | 810 DETROIT ST
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City | DENVER
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State | CO
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Zip | 80206-3836
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Country | US
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Telephone | 720-257-9701
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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. BRANDON DOUGLAS BURELLE
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Credential | PMHNP-BC
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Telephone | 720-257-9701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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