Provider Demographics
NPI:1043492432
Name:BROOKS, SUSAN RENE (LAC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RENE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7413 OLD BEE CAVES RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8234
Mailing Address - Country:US
Mailing Address - Phone:512-450-8290
Mailing Address - Fax:512-450-8290
Practice Address - Street 1:7413 OLD BEE CAVES RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8234
Practice Address - Country:US
Practice Address - Phone:512-450-8290
Practice Address - Fax:512-450-8290
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00787171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist