Provider Demographics
NPI:1063697738
Name:MARK GREBENER, LLC
Entity type:Organization
Organization Name:MARK GREBENER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GREBENER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LAC
Authorized Official - Phone:303-883-4808
Mailing Address - Street 1:1418 E IRWIN LN
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3081
Mailing Address - Country:US
Mailing Address - Phone:303-883-4808
Mailing Address - Fax:303-794-6736
Practice Address - Street 1:7900 E UNION AVE
Practice Address - Street 2:SUITE 1100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2735
Practice Address - Country:US
Practice Address - Phone:303-883-4808
Practice Address - Fax:303-794-6736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLAC127101YA0400X
COCSW4341041C0700X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty