Provider Demographics
NPI:1073368882
Name:BROWN, KYRIA ELIZABETH (CLC)
Entity type:Individual
Prefix:MRS
First Name:KYRIA
Middle Name:ELIZABETH
Last Name:BROWN
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 TAKIN DR
Mailing Address - Street 2:
Mailing Address - City:SEVERANCE
Mailing Address - State:CO
Mailing Address - Zip Code:80550-3810
Mailing Address - Country:US
Mailing Address - Phone:505-331-6301
Mailing Address - Fax:
Practice Address - Street 1:684 TAKIN DR
Practice Address - Street 2:
Practice Address - City:SEVERANCE
Practice Address - State:CO
Practice Address - Zip Code:80550-3810
Practice Address - Country:US
Practice Address - Phone:505-331-6301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COALPP-252152174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist