Basic Information
| Provider Information | |||||||||
| NPI: | 1811121874 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PITCOCK | ||||||||
| FirstName: | BROOKIE | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5310 WARD ROAD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | ARVADA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800021829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778384783 | ||||||||
| FaxNumber: | 8773453501 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 BONFORTE BLVD | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810011801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195455911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2009 | ||||||||
| LastUpdateDate: | 05/06/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 1505 | CO | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.