Provider Demographics
NPI:1033454541
Name:RICHARD J BROOKS, PH.D., P.C.
Entity Type:Organization
Organization Name:RICHARD J BROOKS, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHD
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-751-8311
Mailing Address - Street 1:PO BOX 31708
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1708
Mailing Address - Country:US
Mailing Address - Phone:520-751-8311
Mailing Address - Fax:520-795-3575
Practice Address - Street 1:5210 E PIMA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3664
Practice Address - Country:US
Practice Address - Phone:520-751-8311
Practice Address - Fax:520-795-3575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1315103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS38714Medicare UPIN