Provider Demographics
NPI:1578004230
Name:CROWELL, BREANNA (MA, LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:CROWELL
Suffix:
Gender:F
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:
Other - Last Name:VAN DER MOST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:6909 S HOLLY CIR STE 304
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1045
Mailing Address - Country:US
Mailing Address - Phone:720-722-3036
Mailing Address - Fax:720-202-1681
Practice Address - Street 1:6909 S HOLLY CIR STE 304
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1045
Practice Address - Country:US
Practice Address - Phone:720-722-3036
Practice Address - Fax:720-202-1681
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0013567101YP2500X
COMFT.0001628106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000170095Medicaid