Provider Demographics
NPI:1093980070
Name:BROOKE PSYCHOLOGISTS, LLC
Entity Type:Organization
Organization Name:BROOKE PSYCHOLOGISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:503-481-0020
Mailing Address - Street 1:516 SE MORRISON ST
Mailing Address - Street 2:STE 310
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2327
Mailing Address - Country:US
Mailing Address - Phone:503-235-8696
Mailing Address - Fax:503-232-0791
Practice Address - Street 1:516 SE MORRISON ST
Practice Address - Street 2:STE 310
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2327
Practice Address - Country:US
Practice Address - Phone:503-235-8696
Practice Address - Fax:503-232-0791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003079103TC0700X
OR1623103TC0700X
WAPY00003704103TC0700X
OR1830103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty