Provider Demographics
NPI:1295851483
Name:BRISSENDEN, KIRA J II (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIRA
Middle Name:J
Last Name:BRISSENDEN
Suffix:II
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KIRA
Other - Middle Name:BRISSENDEN
Other - Last Name:ROONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:534 W SYCAMORE CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2260
Mailing Address - Country:US
Mailing Address - Phone:303-931-6240
Mailing Address - Fax:
Practice Address - Street 1:1650 38TH ST STE 100E
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2624
Practice Address - Country:US
Practice Address - Phone:720-421-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9891151041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42801265Medicaid