Provider Demographics
NPI:1285010587
Name:BROGDON, DEREK (LPC, LCDC-INTERN)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:BROGDON
Suffix:
Gender:M
Credentials:LPC, LCDC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 W HAMPDEN AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2110
Mailing Address - Country:US
Mailing Address - Phone:210-907-6248
Mailing Address - Fax:
Practice Address - Street 1:730 W HAMPDEN AVE STE 301
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2110
Practice Address - Country:US
Practice Address - Phone:210-907-6248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70484101Y00000X
COLPC.0014105101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional