Provider Demographics
NPI:1275913154
Name:BROOKS, THERESE R (LMHC)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:R
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 DANIELS ST STE 40
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2954
Mailing Address - Country:US
Mailing Address - Phone:360-909-9637
Mailing Address - Fax:
Practice Address - Street 1:303 N V ST
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-8538
Practice Address - Country:US
Practice Address - Phone:360-909-9637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60560661101YM0800X
WALH60803970101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health