Provider Demographics
NPI:1255469151
Name:BROOKSHIRE, DONALD LYNN (PSYD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:LYNN
Last Name:BROOKSHIRE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 MARKET ST
Mailing Address - Street 2:SUITE 305-B
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-1226
Mailing Address - Country:US
Mailing Address - Phone:423-778-9455
Mailing Address - Fax:423-702-5344
Practice Address - Street 1:325 MARKET ST
Practice Address - Street 2:SUITE 305-B
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-1226
Practice Address - Country:US
Practice Address - Phone:423-778-9455
Practice Address - Fax:423-702-5344
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1743103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3083630OtherBLUECROSS BLUESHIELD TN
TN1515839Medicaid
GA00746853AMedicaid
GA00746853AMedicaid