# FOUR CORNERS MENTAL HEALTH, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528169117
- **Authorized official:** MARK A BRAUNSTEIN DO (OWNER)
- **Authorized official phone:** (970) 382-6690

## Contact information

- **Practice address:** 2855 MAIN AVE, SUITE A105, DURANGO, CO 81301
- **Practice address phone:** (970) 382-6690
- **Practice address fax:** (970) 382-0207
- **Mailing address:** 2855 MAIN AVE, SUITE A105, DURANGO, CO 81301
- **Mailing address phone:** (970) 382-6690
- **Mailing address fax:** (970) 382-0207

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | 40471 | CO | — |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 09/26/2006
- **Last updated:** 06/22/2011