Provider Demographics
NPI:1063766756
Name:BRANDT, FAITH (MED NCC)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:BRANDT
Suffix:
Gender:F
Credentials:MED NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3853
Mailing Address - Country:US
Mailing Address - Phone:970-308-4378
Mailing Address - Fax:
Practice Address - Street 1:513 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3853
Practice Address - Country:US
Practice Address - Phone:970-308-4378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO013305101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health