Provider Demographics
NPI:1023576626
Name:ELSEA, BROOKE E (BCBA)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:E
Last Name:ELSEA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:219 GERALD DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-4111
Mailing Address - Country:US
Mailing Address - Phone:810-618-8370
Mailing Address - Fax:
Practice Address - Street 1:511 W BUTLER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4833
Practice Address - Country:US
Practice Address - Phone:864-757-9918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst