Basic Information
| Provider Information | |||||||||
| NPI: | 1053542365 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIEBENALLER | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | B.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6665 S ELM CIR | ||||||||
| Address2: | |||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801213507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202124790 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1634 DOWNING ST | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802181529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035041830 | ||||||||
| FaxNumber: | 3038948107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2009 | ||||||||
| LastUpdateDate: | 08/04/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.