Provider Demographics
NPI:1326353285
Name:BROOKS, SUSAN A (LMFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:BROOKS
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 1:1961 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ONEKAMA
Mailing Address - State:MI
Mailing Address - Zip Code:49675-8729
Mailing Address - Country:US
Mailing Address - Phone:269-679-7217
Mailing Address - Fax:
Practice Address - Street 1:1961 2ND ST
Practice Address - Street 2:
Practice Address - City:ONEKAMA
Practice Address - State:MI
Practice Address - Zip Code:49675-8729
Practice Address - Country:US
Practice Address - Phone:269-679-7217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI845-124106H00000X
MI4101006415106H00000X
MI6401014076101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional