Provider Demographics
NPI:1275740763
Name:DEACON, BRETT (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:DEACON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E UNIVERSITY AVE
Mailing Address - Street 2:UNIVERSITY OF WYOMING, DEPT. #3415
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82071-2000
Mailing Address - Country:US
Mailing Address - Phone:307-766-3317
Mailing Address - Fax:307-766-2926
Practice Address - Street 1:1000 E UNIVERSITY AVE
Practice Address - Street 2:UNIVERSITY OF WYOMING, DEPT. #3415
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82071-2000
Practice Address - Country:US
Practice Address - Phone:307-766-3317
Practice Address - Fax:307-766-2926
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY411103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical