Provider Demographics
NPI:1407983877
Name:BROMGARD, CAROLE ANN (MA LPC)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:ANN
Last Name:BROMGARD
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:MRS
Other - First Name:CAROLE
Other - Middle Name:ANN
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:756 S BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-3018
Mailing Address - Country:US
Mailing Address - Phone:303-763-8623
Mailing Address - Fax:303-233-9000
Practice Address - Street 1:7114 W JEFFERSON
Practice Address - Street 2:SUITE 111
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2309
Practice Address - Country:US
Practice Address - Phone:303-716-3882
Practice Address - Fax:303-716-3877
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1796101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional