Provider Demographics
NPI:1881147015
Name:SKORNYAKOV, SVETLANA BRUK (MS, MFT)
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:BRUK
Last Name:SKORNYAKOV
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6760 S FULTONDALE CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-4133
Mailing Address - Country:US
Mailing Address - Phone:650-455-5940
Mailing Address - Fax:
Practice Address - Street 1:2600 SOUTH PARKER RD
Practice Address - Street 2:BUILDING 5 SUITE 155
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:720-669-3962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-23
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT93502106H00000X
COMFT0001557106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist