Basic Information
| Provider Information | |||||||||
| NPI: | 1639676158 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE BRUIN | ||||||||
| FirstName: | CHRIS | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | GRAND JUNCTION METRO TREATMENT CENTER | ||||||||
| Address2: | 1001 WELLINGTON AVE | ||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702081130 | ||||||||
| FaxNumber: | 9702081132 | ||||||||
| Practice Location | |||||||||
| Address1: | GRAND JUNCTION METRO TREATMENT CENTER | ||||||||
| Address2: | 1001 WELLINGTON AVE | ||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702081130 | ||||||||
| FaxNumber: | 9702081132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2018 | ||||||||
| LastUpdateDate: | 04/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 617 | CO | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YA0400X | 3394 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.