Provider Demographics
NPI:1700606050
Name:COURAGEOUS LIFE COLORADO
Entity type:Organization
Organization Name:COURAGEOUS LIFE COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-474-3857
Mailing Address - Street 1:8740 ARISTA PL UNIT 4408
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4982
Mailing Address - Country:US
Mailing Address - Phone:720-474-3857
Mailing Address - Fax:
Practice Address - Street 1:8740 ARISTA PL UNIT 4408
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-4982
Practice Address - Country:US
Practice Address - Phone:720-474-3857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health