Provider Demographics
NPI:1164614392
Name:WILBRAHAM, BROOKE (LMSW)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:WILBRAHAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 EAST AVE
Mailing Address - Street 2:ACT TEAM
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4323
Mailing Address - Country:US
Mailing Address - Phone:512-703-1340
Mailing Address - Fax:512-804-3479
Practice Address - Street 1:56 EAST AVE
Practice Address - Street 2:ACT TEAM
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-4323
Practice Address - Country:US
Practice Address - Phone:512-703-1340
Practice Address - Fax:512-804-3479
Is Sole Proprietor?:No
Enumeration Date:2007-08-12
Last Update Date:2007-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50979104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker