Provider Demographics
NPI:1881287662
Name:BOECKER, BRIAN BRUCE (LPC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:BRUCE
Last Name:BOECKER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5984 S PRINCE ST STE 203
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-2098
Mailing Address - Country:US
Mailing Address - Phone:720-468-0503
Mailing Address - Fax:
Practice Address - Street 1:5984 S PRINCE ST STE 203
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-2098
Practice Address - Country:US
Practice Address - Phone:720-468-0503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health