Basic Information
| Provider Information | |||||||||
| NPI: | 1912389990 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VETERANS ADMINISTRATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 990 N LOGAN ST | ||||||||
| Address2: | #604 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802033064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7203223556 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1055 CLERMONT ST | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802203808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033998020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2015 | ||||||||
| LastUpdateDate: | 06/25/2015 | ||||||||
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| AuthorizedOfficialLastName: | LUND | ||||||||
| AuthorizedOfficialFirstName: | BRANDI | ||||||||
| AuthorizedOfficialMiddleName: | RAE | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 7203223556 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 286500000X | CSW .09923215 | CO | Y | Hospitals | Military Hospital |
No ID Information.