1578740239 NPI number — MRS. LUCIE W BROSSARD M.A., LPC

Table of content: MRS. LUCIE W BROSSARD M.A., LPC (NPI 1578740239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578740239 NPI number — MRS. LUCIE W BROSSARD M.A., LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROSSARD
Provider First Name:
LUCIE
Provider Middle Name:
W
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIWIMAGI
Provider Other First Name:
LUCIE
Provider Other Middle Name:
BROSSARD
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578740239
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1870 W 122ND AVE STE 100
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:
80234-2075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-853-3500
Provider Business Mailing Address Fax Number:
303-853-3702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8989 HURON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THORNTON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80260-6858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-853-3500
Provider Business Practice Location Address Fax Number:
303-853-3702
Provider Enumeration Date:
01/24/2008

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: 101YP2500X , with the licence number:  3265 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LPC.0003265 , 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)