Provider Demographics
NPI:1225222854
Name:O'REILLY, BRENDA K (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:K
Last Name:O'REILLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 REDWING RD
Mailing Address - Street 2:SUITE 316
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6315
Mailing Address - Country:US
Mailing Address - Phone:970-613-4172
Mailing Address - Fax:970-223-1325
Practice Address - Street 1:2629 REDWING RD
Practice Address - Street 2:SUITE 316
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6315
Practice Address - Country:US
Practice Address - Phone:970-613-4172
Practice Address - Fax:970-223-1325
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1767103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47036362Medicaid
CO47036362Medicaid