Provider Demographics
NPI:1407279052
Name:BUSTOS, BRANDY (BA)
Entity Type:Individual
Prefix:MISS
First Name:BRANDY
Middle Name:
Last Name:BUSTOS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 LIPAN ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80260-4912
Mailing Address - Country:US
Mailing Address - Phone:303-412-3829
Mailing Address - Fax:303-412-3376
Practice Address - Street 1:4335 W 76TH AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030-4604
Practice Address - Country:US
Practice Address - Phone:303-412-3829
Practice Address - Fax:303-412-3376
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC0103321101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)