Provider Demographics
NPI:1225740863
Name:ELENBAAS TEN HAGEN, BROOKE LYNNE (LMSW)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:LYNNE
Last Name:ELENBAAS TEN HAGEN
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 1:8333 FELCH ST
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-2608
Mailing Address - Country:US
Mailing Address - Phone:616-748-3573
Mailing Address - Fax:
Practice Address - Street 1:8333 FELCH ST
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-2608
Practice Address - Country:US
Practice Address - Phone:616-391-1774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011167651041C0700X
MI68511101531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical