Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 6049 | CO |
NPI | 1003220070 |
---|---|
Provider Name | Jessica Brien |
First Address | Loveland, CO 80537-5502 |
Second Address | Loveland, CO 80537-5502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2014 |
Last Update Date | 12/04/2021 |