Provider Demographics
NPI:1003132820
Name:BROOK, SUSAN WEISS (MA, LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:WEISS
Last Name:BROOK
Suffix:
Gender:F
Credentials:MA, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SUSAN LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2618
Mailing Address - Country:US
Mailing Address - Phone:541-488-8003
Mailing Address - Fax:
Practice Address - Street 1:125 SUSAN LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2618
Practice Address - Country:US
Practice Address - Phone:541-488-8003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLPC1061101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health