Provider Demographics
NPI:1740507656
Name:GONZALEZ, BREANN ALEIGH (MA)
Entity type:Individual
Prefix:MS
First Name:BREANN
Middle Name:ALEIGH
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9808 RAPP LN
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80260-5630
Mailing Address - Country:US
Mailing Address - Phone:720-982-7888
Mailing Address - Fax:
Practice Address - Street 1:1312 17TH ST
Practice Address - Street 2:SUITE 146
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1508
Practice Address - Country:US
Practice Address - Phone:720-982-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-02
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-14-15946103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst