Provider Demographics
NPI:1073048500
Name:BROOKING, ANN MARIE (LMHCA, SUDP, MA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:BROOKING
Suffix:
Gender:F
Credentials:LMHCA, SUDP, MA
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:16331 COLONY RD
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:WA
Mailing Address - Zip Code:98232-8513
Mailing Address - Country:US
Mailing Address - Phone:360-770-7894
Mailing Address - Fax:
Practice Address - Street 1:16331 COLONY RD
Practice Address - Street 2:
Practice Address - City:BOW
Practice Address - State:WA
Practice Address - Zip Code:98232-8513
Practice Address - Country:US
Practice Address - Phone:360-770-7894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61106515101YA0400X
WA60840388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)