Provider Demographics
NPI:1033992888
Name:BRIGHAM, BROOKE STEPHANIE (MS, PSYS)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:STEPHANIE
Last Name:BRIGHAM
Suffix:
Gender:F
Credentials:MS, PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-8804
Mailing Address - Country:US
Mailing Address - Phone:616-298-6937
Mailing Address - Fax:
Practice Address - Street 1:1331 MARTIN LUTHER KING JR ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2634
Practice Address - Country:US
Practice Address - Phone:616-819-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPP0000001117949103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool