MEDICARE: ILENE BRANDON

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	101YP2500X	Professional Counselor	NLC0107086	CO

General Provider Information

NPI Number	:	1649768813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILENE BRANDON

Provider Business Mailing Address
First Line	:	4999 ASHBROOK CIR
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80130-8923
Country	:	US
Telephone Number	:	303-726-5379
Fax Number	:

Provider Business Practice Location Address
First Line	:	8191 SOUTHPARK LN UNIT 201
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80120-4641
Country	:	US
Telephone Number	:	303-726-5379
Fax Number	:

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

Provider Enumeration Date	:	04/24/2018
Last Update Date	:	04/24/2018

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Directions to “ ILENE BRANDON ” Practice Location

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