Provider Demographics
NPI:1235372723
Name:CASEY, BROOKE LYMAN (LMFT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:LYMAN
Last Name:CASEY
Suffix:
Gender:F
Credentials:LMFT
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 224
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-0224
Mailing Address - Country:US
Mailing Address - Phone:707-326-9934
Mailing Address - Fax:
Practice Address - Street 1:709 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2920
Practice Address - Country:US
Practice Address - Phone:707-326-9934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT INTERN 95895101YM0800X
CA11030216174N00000X
CALM286176B00000X
390200000X
CA111272106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No176B00000XOther Service ProvidersMidwife
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program