Provider Demographics
NPI:1609763028
Name:BROYLES, DENICE
Entity type:Individual
Prefix:
First Name:DENICE
Middle Name:
Last Name:BROYLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13892 COUNTY ROAD 104 S
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-9186
Mailing Address - Country:US
Mailing Address - Phone:719-588-9405
Mailing Address - Fax:
Practice Address - Street 1:14385 COUNTY ROAD P
Practice Address - Street 2:
Practice Address - City:LA JARA
Practice Address - State:CO
Practice Address - Zip Code:81140-9584
Practice Address - Country:US
Practice Address - Phone:719-992-4260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0023369101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty