Healthcare Provider Details

I. General information

NPI: 1336156306
Provider Name (Legal Business Name): RICHARD JOSEPH BROOKS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 E PIMA SUITE 200
TUCSON AZ
85712-3678
US

IV. Provider business mailing address

PO BOX 31708
TUCSON AZ
85751-1708
US

V. Phone/Fax

Practice location:
  • Phone: 520-751-8311
  • Fax: 520-795-3575
Mailing address:
  • Phone: 520-751-8311
  • Fax: 520-795-3575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1315
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: