Provider Demographics
NPI:1558462481
Name:GREBENER, MARK LED (LCSW LAC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:LED
Last Name:GREBENER
Suffix:
Gender:M
Credentials:LCSW LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 E IRWIN LANE
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122
Mailing Address - Country:US
Mailing Address - Phone:303-883-4808
Mailing Address - Fax:303-794-6736
Practice Address - Street 1:5574 S PRINCE ST
Practice Address - Street 2:#11
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120
Practice Address - Country:US
Practice Address - Phone:303-883-4808
Practice Address - Fax:303-794-6736
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLAC 127101YA0400X
COCSW 4341041C0700X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical