Provider Demographics
NPI:1649319328
Name:MUNROE, BRYAN D (PHD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:D
Last Name:MUNROE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 WILFRED RD
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-8106
Mailing Address - Country:US
Mailing Address - Phone:303-651-1881
Mailing Address - Fax:303-651-2099
Practice Address - Street 1:421 21ST AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1469
Practice Address - Country:US
Practice Address - Phone:303-651-1881
Practice Address - Fax:303-651-2099
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC 13101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional