Provider Demographics
NPI:1386276475
Name:BILLS, BRYAN MILLER
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:MILLER
Last Name:BILLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 SCOTT BLVD APT 304
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-7596
Mailing Address - Country:US
Mailing Address - Phone:720-955-6633
Mailing Address - Fax:
Practice Address - Street 1:525 SCOTT BLVD APT 304
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7596
Practice Address - Country:US
Practice Address - Phone:720-955-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician