Provider Demographics
NPI:1235888744
Name:PICHLER, BRENT GERALD (MED)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:GERALD
Last Name:PICHLER
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 N COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6653
Mailing Address - Country:US
Mailing Address - Phone:520-390-6908
Mailing Address - Fax:520-844-1103
Practice Address - Street 1:4405 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6653
Practice Address - Country:US
Practice Address - Phone:520-390-6908
Practice Address - Fax:520-844-1103
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC0251101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health