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NPI Code Detail

MEDICARE: MS. KIRA J BRISSENDEN II L.C.S.W.

MEDICARE: MS. KIRA J BRISSENDEN II L.C.S.W.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker989115CO
2101YM0800XMental Health Counselor989115CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295851483
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIRA J BRISSENDEN II L.C.S.W.
Provider Business Mailing Address
First Line : 534 W SYCAMORE CIR
Second Line :
City : LOUISVILLE
State : CO
Zip : 80027-2260
Country : US
Telephone Number : 303-931-6240
Fax Number :
Provider Business Practice Location Address
First Line : 1650 38TH ST STE 100E
Second Line :
City : BOULDER
State : CO
Zip : 80301-2624
Country : US
Telephone Number : 720-421-8550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/11/2019

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