Provider Demographics
NPI:1073080669
Name:CANADAY, BROOKS
Entity Type:Individual
Prefix:
First Name:BROOKS
Middle Name:
Last Name:CANADAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 S ONEIDA ST STE 600
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2555
Mailing Address - Country:US
Mailing Address - Phone:720-863-6100
Mailing Address - Fax:
Practice Address - Street 1:2121 S ONEIDA ST STE 600
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-2555
Practice Address - Country:US
Practice Address - Phone:720-863-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101Y00000X
COLPC.0017014101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor