Provider Demographics
NPI:1083729776
Name:BRANDON, ALLEN D (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:D
Last Name:BRANDON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1236 E ELIZABETH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4000
Mailing Address - Country:US
Mailing Address - Phone:970-488-1668
Mailing Address - Fax:970-472-9381
Practice Address - Street 1:375 E HORSETOOTH RD
Practice Address - Street 2:BUILDING 2; STE. 111
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3155
Practice Address - Country:US
Practice Address - Phone:970-223-1293
Practice Address - Fax:970-225-0861
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO1250103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07012503Medicaid
COC504538Medicare PIN