Provider Demographics
NPI:1043368509
Name:PREYLO, BROOKE J D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:J D
Last Name:PREYLO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:895 FAIRWAY DR.
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-2019
Mailing Address - Country:US
Mailing Address - Phone:660-646-4655
Mailing Address - Fax:
Practice Address - Street 1:895 FAIRWAY DR.
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-2019
Practice Address - Country:US
Practice Address - Phone:660-646-4655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101Y00000X
MO2008032456103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494447303Medicaid