1558984005 NPI number — BRILLIANTLY SANE COUNSELING AND COACHING LLC

Table of content: (NPI 1558984005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558984005 NPI number — BRILLIANTLY SANE COUNSELING AND COACHING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRILLIANTLY SANE COUNSELING AND COACHING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558984005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1211
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVERTHORNE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80498-1211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-389-3612
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 BRADLEY CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOULDER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80305-7310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-368-9185
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2020

Additional Information

Authorized Official

Authorized Official Last Name:
WALLACE
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
970-368-9185

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com