1194307538 NPI number — MRS. AMY RENEE BRISSETTE LCSW

Table of content: MRS. AMY RENEE BRISSETTE LCSW (NPI 1194307538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194307538 NPI number — MRS. AMY RENEE BRISSETTE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRISSETTE
Provider First Name:
AMY
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HINKLE
Provider Other First Name:
AMY
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194307538
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8003 RALEIGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80031-4313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 S. COLORADO BLVD
Provider Second Line Business Practice Location Address:
TOWER 1, STE 2000-4
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80222-7900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-884-9682
Provider Business Practice Location Address Fax Number:
303-474-6521
Provider Enumeration Date:
04/26/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CSW.09926896 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9000171712 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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