Provider Demographics
NPI:1043696859
Name:THOMAS, BROOKE (LADC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:COHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7100 WAVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:NICHOLS HILLS
Mailing Address - State:OK
Mailing Address - Zip Code:73116-5209
Mailing Address - Country:US
Mailing Address - Phone:405-942-5955
Mailing Address - Fax:405-275-5132
Practice Address - Street 1:1010 E 45TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-2202
Practice Address - Country:US
Practice Address - Phone:405-273-1170
Practice Address - Fax:405-275-5132
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK508101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK508Medicaid