| Doctor Name: | DR. BROOKE KISH |
| NPI Number: | 1003048497 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 0380805 |
| Business Practice Address: | 9397 Crown Crest Blvd Parker, CO - 801388575 |
| Business Phone Number: | 3033492691 |
| Business Fax Number: | |
| Mailing Address: | 30424 Upper Bear Creek Rd, EVERGREEN |
| State: | CO |
| Postal Code: | 804397715 |
| Phone Number: | 3033492691 |
| Fax Number: | |
| NPI Enumeration Date: | 08/18/2009 |
| NPI Last Update Date: | 08/18/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | 0380805 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |