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General NPI Number Information
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NPI Number | 1891936308
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Entity Type | Organization
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Legal Business Name | THE BRAIN HEALTH PSYCHOTHERAPY CENTER P.C.
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 1400 MAIN ST. SUITE 200
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City | LOUISVILLE
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State | CO
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Zip | 80027
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Country | US
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Telephone | 303-666-1081
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Fax | 303-666-1082
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Provider Business Mailing Address
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Address Line | 1400 MAIN ST. SUITE 200
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City | LOUISVILLE
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State | CO
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Zip | 80027
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Country | US
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Telephone | 303-666-1081
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Fax | 303-666-1082
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. KATHLEEN H SHIELDS
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Credential |
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Telephone | 3037205819890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 991522
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License Number State | CO
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