Provider Demographics
NPI:1881241131
Name:BURELLE, BRANDON DOUGLAS (PMHMP-BC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:DOUGLAS
Last Name:BURELLE
Suffix:
Gender:M
Credentials:PMHMP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-3836
Mailing Address - Country:US
Mailing Address - Phone:303-886-7641
Mailing Address - Fax:
Practice Address - Street 1:1600 N PENNSYLVANIA ST STE 101
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-1303
Practice Address - Country:US
Practice Address - Phone:720-527-9701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994905-NP363LP0808X
CO091111163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse