Healthcare Provider Details

I. General information

NPI: 1255662730
Provider Name (Legal Business Name): SCOTT RICHARD BROWN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 30TH ST STE 202
BOULDER CO
80301
US

IV. Provider business mailing address

2500 30TH ST STE 202
BOULDER CO
80301-1258
US

V. Phone/Fax

Practice location:
  • Phone: 303-444-8822
  • Fax:
Mailing address:
  • Phone: 303-444-8822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number2432
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2432
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: