Provider Demographics
NPI:1033540018
Name:BROWN, TRINA RENEE (MFTI)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:RENEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:TRINA
Other - Middle Name:RENEE
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2825 MARINE ST STE 203
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1027
Mailing Address - Country:US
Mailing Address - Phone:720-605-6605
Mailing Address - Fax:
Practice Address - Street 1:2825 MARINE ST STE 203
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1027
Practice Address - Country:US
Practice Address - Phone:720-605-6605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 73553106H00000X
COMFT.0001596106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty