Provider Demographics
NPI:1720227531
Name:BROST, JEB E (CACIII)
Entity Type:Individual
Prefix:
First Name:JEB
Middle Name:E
Last Name:BROST
Suffix:
Gender:M
Credentials:CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1208
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81402-1208
Mailing Address - Country:US
Mailing Address - Phone:970-252-3200
Mailing Address - Fax:970-252-3208
Practice Address - Street 1:2130 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3834
Practice Address - Country:US
Practice Address - Phone:970-252-3200
Practice Address - Fax:970-252-3208
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC-6517101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)