Provider Demographics
NPI:1053542365
Name:SIEBENALLER, BRADLEY MICHAEL (BS)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:MICHAEL
Last Name:SIEBENALLER
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6665 S ELM CIR
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80121-3507
Mailing Address - Country:US
Mailing Address - Phone:720-212-4790
Mailing Address - Fax:
Practice Address - Street 1:1634 DOWNING ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1529
Practice Address - Country:US
Practice Address - Phone:303-504-1830
Practice Address - Fax:303-894-8107
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health