Provider Demographics
NPI:1073156303
Name:BRUTSCH, KELLY JOY
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JOY
Last Name:BRUTSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12314 W. STANFORD DR.
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465
Mailing Address - Country:US
Mailing Address - Phone:480-229-7044
Mailing Address - Fax:
Practice Address - Street 1:8191 SOUTHPARK LANE SUITE 201
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120
Practice Address - Country:US
Practice Address - Phone:480-229-7044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0016522101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor