Provider Demographics
NPI:1093964033
Name:BROOKS, JANE SMITH (LMHC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:SMITH
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34656-0428
Mailing Address - Country:US
Mailing Address - Phone:727-841-4200
Mailing Address - Fax:727-841-4354
Practice Address - Street 1:7074 GROVE RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34609-8658
Practice Address - Country:US
Practice Address - Phone:352-540-9335
Practice Address - Fax:352-544-0722
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5466101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL763100600Medicaid
FL767408200Medicaid