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General NPI Number Information
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NPI Number | 1225697279
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Entity Type | Individual
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Provider Name | BRANDON A PEREA-HICKAM PHD, BCBA, LMFT, LAC
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Gender | Male
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 954 5TH AVE
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City | LONGMONT
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State | CO
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Zip | 80501-5424
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Country | US
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Telephone | 720-461-4874
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Fax |
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Provider Business Mailing Address
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Address Line | 954 5TH AVE
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City | LONGMONT
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State | CO
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Zip | 80501-5424
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Country | US
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Telephone | 720-461-4874
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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