Healthcare Provider Details

I. General information

NPI: 1619225125
Provider Name (Legal Business Name): BRANDI NICOLE WHITAKER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRANDI NICOLE YOUNG

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4597
US

IV. Provider business mailing address

1 CHILDRENS WAY
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-2715
  • Fax:
Mailing address:
  • Phone: 501-364-1021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY.0006788
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number12-14P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: