Individual
DR. PHOUTHDAVONE PHIMPHASONE-BRADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
13001 E 17TH PL FL 2, AURORA, CO 80045-2570
(303) 724-1000
(303) 724-9472
Mailing address
PO BOX 110429, AURORA, CO 80042-0429
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSYC.0005074
CO
103TH0100X
Health Service Psychologist
PSYC.0005074
CO
Other
Enumeration date
11/16/2017
Last updated
01/29/2020
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