Provider Demographics
NPI:1033510078
Name:HARRISON, BROOKE L (LMHC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:L
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 800
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-0800
Mailing Address - Country:US
Mailing Address - Phone:850-712-3779
Mailing Address - Fax:
Practice Address - Street 1:203 CLOVERDALE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1405
Practice Address - Country:US
Practice Address - Phone:850-712-3779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12824101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health