Provider Demographics
NPI:1346491727
Name:DEY, BROOKE M (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:M
Last Name:DEY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 MANITOWOC RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-5323
Mailing Address - Country:US
Mailing Address - Phone:920-544-6818
Mailing Address - Fax:920-212-4997
Practice Address - Street 1:2301 RIVERSIDE DR STE B11
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-1957
Practice Address - Country:US
Practice Address - Phone:920-544-6818
Practice Address - Fax:920-212-4997
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5388-125101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional