Provider Demographics
NPI:1275806366
Name:BRODY, BRIAN CHARLES (PSY D)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CHARLES
Last Name:BRODY
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 620430
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80162-0430
Mailing Address - Country:US
Mailing Address - Phone:303-979-0319
Mailing Address - Fax:303-979-1334
Practice Address - Street 1:6901 S PIERCE ST
Practice Address - Street 2:SUITE 100M
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-4552
Practice Address - Country:US
Practice Address - Phone:303-979-0319
Practice Address - Fax:303-979-1334
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1615103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral