MEDICARE: DR. ALLEN D. BRANDON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1250	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083729776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLEN D. BRANDON PH.D.

Provider Business Mailing Address
First Line	:	1236 E ELIZABETH ST
Second Line	:	SUITE 2
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4000
Country	:	US
Telephone Number	:	970-488-1668
Fax Number	:	970-472-9381

Provider Business Practice Location Address
First Line	:	375 E HORSETOOTH RD
Second Line	:	BUILDING 2; STE. 111
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3155
Country	:	US
Telephone Number	:	970-223-1293
Fax Number	:	970-225-0861

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	04/01/2014

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