Provider Demographics
NPI:1366612921
Name:JONATHAN K. BROOKS PHD PC
Entity type:Organization
Organization Name:JONATHAN K. BROOKS PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-838-7595
Mailing Address - Street 1:29029 UPPER BEAR CREEK RD
Mailing Address - Street 2:#305
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7738
Mailing Address - Country:US
Mailing Address - Phone:303-838-7595
Mailing Address - Fax:
Practice Address - Street 1:29029 UPPER BEAR CREEK RD
Practice Address - Street 2:#305
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7738
Practice Address - Country:US
Practice Address - Phone:303-838-7595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2815103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty