Provider Demographics
NPI:1265855274
Name:BROOKS, ALEXIS LYNNE
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LYNNE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 ALDEN ST
Mailing Address - Street 2:BOX 3001
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109-3707
Mailing Address - Country:US
Mailing Address - Phone:413-238-1502
Mailing Address - Fax:
Practice Address - Street 1:155 MAPLE ST
Practice Address - Street 2:STE 402
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-2649
Practice Address - Country:US
Practice Address - Phone:413-747-0829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health