Provider Demographics
NPI:1629577002
Name:NEURO COLORADO LOC
Entity Type:Organization
Organization Name:NEURO COLORADO LOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:720-232-0834
Mailing Address - Street 1:1777 S BELLAIRE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4310
Mailing Address - Country:US
Mailing Address - Phone:720-232-0834
Mailing Address - Fax:
Practice Address - Street 1:1777 S BELLAIRE ST STE 102
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4310
Practice Address - Country:US
Practice Address - Phone:720-232-0834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11636101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty