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General NPI Number Information
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NPI Number | 1750699211
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Entity Type | Individual
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Provider Name | MARK ALAN BROSAL MA. LPC
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Gender | Male
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Dates
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Enumeration Date | 09/18/2010
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Last Update Date | 09/18/2010
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Provider Practice Location Address
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Address Line | 317 URANUS ST
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City | FORT COLLINS
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State | CO
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Zip | 80525-4050
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Country | US
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Telephone | 970-215-6806
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Fax | 970-282-3734
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Provider Business Mailing Address
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Address Line | 317 URANUS ST
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City | FORT COLLINS
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State | CO
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Zip | 80525-4050
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Country | US
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Telephone | 970-215-6806
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Fax | 970-282-3734
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1317
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License Number State | CO
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