Provider Demographics
NPI:1396051108
Name:DOUBRAVA, ADRIENNE N (PSYD)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:N
Last Name:DOUBRAVA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:N
Other - Last Name:BURRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:200 S WILCOX ST PMB 142
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1913
Mailing Address - Country:US
Mailing Address - Phone:720-323-8634
Mailing Address - Fax:
Practice Address - Street 1:405 S WILCOX ST STE 104
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1957
Practice Address - Country:US
Practice Address - Phone:720-323-8634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY0005447103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12740537OtherCAQH