| Brooke Lee, Llc | |
|
226 Mt Harvard Ave Severance CO 80550-4870 | |
| (970) 412-4176 | |
| Not Available |
| Full Name | Brooke Lee, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 226 Mt Harvard Ave, Severance, Colorado |
| Authorized Official Name and Position | Brooke Lee (OWNER) |
| Authorized Official Contact | 9704608494 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brooke Lee, Llc 226 Mt Harvard Ave Severance CO 80550-4870 Ph: (970) 412-4176 | Brooke Lee, Llc 226 Mt Harvard Ave Severance CO 80550-4870 Ph: (970) 412-4176 |
| NPI Number | 1124626817 |
|---|---|
| Provider Enumeration Date | 10/14/2020 |
| Last Update Date | 10/14/2020 |
| Certification Date | 10/14/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124626817 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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