MEDICARE: SHELLEY R. BRANNON LMFT

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	106H00000X	Marriage & Family Therapist	0001396	CO

General Provider Information

NPI Number	:	1568709533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY R. BRANNON LMFT

Provider Business Mailing Address
First Line	:	6360 E MISSISSIPPI AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80224-1454
Country	:	US
Telephone Number	:	720-466-5586
Fax Number	:

Provider Business Practice Location Address
First Line	:	6360 E MISSISSIPPI AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80224-1454
Country	:	US
Telephone Number	:	720-466-5586
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2013
Last Update Date	:	07/21/2022

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