Provider Demographics
NPI:1407165491
Name:GARCIA-BRAUCH, KELLY ANN (MA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:GARCIA-BRAUCH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1496 S BRENTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-5331
Mailing Address - Country:US
Mailing Address - Phone:303-829-7904
Mailing Address - Fax:
Practice Address - Street 1:1496 S BRENTWOOD ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-5331
Practice Address - Country:US
Practice Address - Phone:303-829-7904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11221101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty