Provider Demographics
NPI:1801287586
Name:BREANNE NEWCOMB
Entity type:Organization
Organization Name:BREANNE NEWCOMB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CBRS
Authorized Official - Prefix:
Authorized Official - First Name:BREANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:720-409-6902
Mailing Address - Street 1:53 BLOOMINGDALE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:NC
Mailing Address - Zip Code:28701-9134
Mailing Address - Country:US
Mailing Address - Phone:720-409-6902
Mailing Address - Fax:
Practice Address - Street 1:53 BLOOMINGDALE DR
Practice Address - Street 2:
Practice Address - City:ALEXANDER
Practice Address - State:NC
Practice Address - Zip Code:28701-9134
Practice Address - Country:US
Practice Address - Phone:720-409-6902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103770251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health