Provider Demographics
NPI:1710723671
Name:GALLEGOS, BREANN ELIZABETH
Entity type:Individual
Prefix:
First Name:BREANN
Middle Name:ELIZABETH
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 S FLOWER ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-1206
Mailing Address - Country:US
Mailing Address - Phone:303-704-5683
Mailing Address - Fax:
Practice Address - Street 1:45 S FLOWER ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-1206
Practice Address - Country:US
Practice Address - Phone:303-704-5683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician