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General NPI Number Information
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NPI Number | 1881147015
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Entity Type | Individual
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Provider Name | SVETLANA BRUK SKORNYAKOV M.S., MFT
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Gender | Female
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Dates
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Enumeration Date | 07/23/2016
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 2600 SOUTH PARKER RD BUILDING 5 SUITE 155
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City | AURORA
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State | CO
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Zip | 80014
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Country | US
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Telephone | 720-669-3962
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Fax |
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Provider Business Mailing Address
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Address Line | 6760 S FULTONDALE CT
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City | AURORA
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State | CO
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Zip | 80016-4133
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Country | US
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Telephone | 650-455-5940
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT93502
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT0001557
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License Number State | CO
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