Provider Demographics
NPI:1407109010
Name:RANDY A BRALEY PHD LMFT LLC
Entity Type:Organization
Organization Name:RANDY A BRALEY PHD LMFT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRALEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-726-8754
Mailing Address - Street 1:5310 WARD RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1832
Mailing Address - Country:US
Mailing Address - Phone:303-278-7418
Mailing Address - Fax:888-341-5050
Practice Address - Street 1:2201 DOWNING ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5234
Practice Address - Country:US
Practice Address - Phone:303-278-7418
Practice Address - Fax:888-341-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3770103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3770OtherPROFESSIONAL LICENSE