Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 2327 | CO |
Y | 103T00000X | Psychologist | 2327 | CO |
NPI | 1013030923 |
---|---|
Provider Name | Dr. Brennan Lynn Mars |
First Address | Boulder, CO 80303 |
Second Address | Boulder, CO 80303-2643 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 16/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
58079831 | (05) | CO |