Provider Demographics
NPI:1295802189
Name:BRIM, SANDRA JEANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:JEANNE
Last Name:BRIM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-5446
Mailing Address - Country:US
Mailing Address - Phone:424-355-3697
Mailing Address - Fax:970-966-8905
Practice Address - Street 1:321 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-5446
Practice Address - Country:US
Practice Address - Phone:424-355-3697
Practice Address - Fax:970-966-8905
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6790103T00000X
AZ3205103TC0700X
COPSY5844103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical