Provider Demographics
NPI:1457536195
Name:ALICE S. BRILL, PH.D. PC
Entity Type:Organization
Organization Name:ALICE S. BRILL, PH.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:SARA
Authorized Official - Last Name:BRILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-633-3035
Mailing Address - Street 1:PO BOX 2350
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-2350
Mailing Address - Country:US
Mailing Address - Phone:719-633-3035
Mailing Address - Fax:719-389-0464
Practice Address - Street 1:130 E MONUMENT ST STE 102
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1061
Practice Address - Country:US
Practice Address - Phone:719-633-3035
Practice Address - Fax:719-389-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO897103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC9563-6Medicare PIN