Provider Demographics
NPI:1043326275
Name:BROOKS, ANTHONY WILLIAM (LCPC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:WILLIAM
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9126 LA CROSSE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1328
Mailing Address - Country:US
Mailing Address - Phone:847-208-4896
Mailing Address - Fax:
Practice Address - Street 1:9126 LA CROSSE AVE APT 1
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1328
Practice Address - Country:US
Practice Address - Phone:847-208-4896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001636028Medicare UPIN