Provider Demographics
NPI:1154672574
Name:BROOKS, GARY ROGER (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ROGER
Last Name:BROOKS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2027 S 61ST ST
Mailing Address - Street 2:SUITE 122
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-6867
Mailing Address - Country:US
Mailing Address - Phone:254-778-6922
Mailing Address - Fax:254-778-4332
Practice Address - Street 1:2027 S 61ST ST
Practice Address - Street 2:SUITE 122
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-6867
Practice Address - Country:US
Practice Address - Phone:254-778-6922
Practice Address - Fax:254-778-4332
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0-1381103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist