Provider Demographics
NPI:1750336293
Name:BRAUNLICH, JOY C (LCSW)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:C
Last Name:BRAUNLICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 CENTENNIAL BLVD UNIT 50304
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80949-0150
Mailing Address - Country:US
Mailing Address - Phone:719-338-7102
Mailing Address - Fax:866-780-3596
Practice Address - Street 1:5245 CENTENNIAL BLVD
Practice Address - Street 2:200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919
Practice Address - Country:US
Practice Address - Phone:719-338-9404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0049821041C0700X
CO20481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11572140OtherCAQH
COCSW.00002048OtherPROFESSIONAL LICENSE
NC510566506Medicare UPIN