Provider Demographics
NPI:1083114565
Name:DEREK BROGDON PLLC
Entity Type:Organization
Organization Name:DEREK BROGDON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:BROGDON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:210-907-6248
Mailing Address - Street 1:730 W HAMPDEN AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2110
Mailing Address - Country:US
Mailing Address - Phone:210-907-6248
Mailing Address - Fax:
Practice Address - Street 1:730 W HAMPDEN AVE STE 301
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2110
Practice Address - Country:US
Practice Address - Phone:210-907-6248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty