Provider Demographics
NPI:1245071265
Name:BRANNAN, WILLIAM ANDREW
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ANDREW
Last Name:BRANNAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DREW
Other - Middle Name:
Other - Last Name:BRANNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7369 S SHADY GROVE WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5475
Mailing Address - Country:US
Mailing Address - Phone:970-620-2043
Mailing Address - Fax:
Practice Address - Street 1:18801 E MAINSTREET STE 180
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3477
Practice Address - Country:US
Practice Address - Phone:720-727-1738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician