Provider Demographics
NPI:1851901045
Name:BRIM, RODNEY MARTIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:MARTIN
Last Name:BRIM
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 1:301 NAUTICAL HTS
Mailing Address - Street 2:
Mailing Address - City:SMITH RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95567-9568
Mailing Address - Country:US
Mailing Address - Phone:541-813-9173
Mailing Address - Fax:
Practice Address - Street 1:301 NAUTICAL HTS
Practice Address - Street 2:
Practice Address - City:SMITH RIVER
Practice Address - State:CA
Practice Address - Zip Code:95567-9568
Practice Address - Country:US
Practice Address - Phone:541-813-9173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31897103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical