Provider Demographics
NPI:1225399686
Name:BRUDNO, ELAAN MARISSA (LPC)
Entity type:Individual
Prefix:MS
First Name:ELAAN
Middle Name:MARISSA
Last Name:BRUDNO
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:NIWOT
Mailing Address - State:CO
Mailing Address - Zip Code:80544-0386
Mailing Address - Country:US
Mailing Address - Phone:720-556-3074
Mailing Address - Fax:866-757-5778
Practice Address - Street 1:6964 N 79TH ST
Practice Address - Street 2:#4
Practice Address - City:NIWOT
Practice Address - State:CO
Practice Address - Zip Code:80503-8980
Practice Address - Country:US
Practice Address - Phone:720-556-3074
Practice Address - Fax:866-757-5778
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0021463101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health