Provider Demographics
NPI:1396507653
Name:METZGER, BRANDY JO
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:JO
Last Name:METZGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16438 COUNTY ROAD 169
Mailing Address - Street 2:
Mailing Address - City:MATHESON
Mailing Address - State:CO
Mailing Address - Zip Code:80830-9604
Mailing Address - Country:US
Mailing Address - Phone:720-810-7990
Mailing Address - Fax:
Practice Address - Street 1:2960 N ACADEMY BLVD STE 203
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5303
Practice Address - Country:US
Practice Address - Phone:720-810-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0021597101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health