Provider Demographics
NPI:1356827406
Name:TOMERIAL BROOKS LCSW, MBA COUNSELING SERVICES
Entity Type:Organization
Organization Name:TOMERIAL BROOKS LCSW, MBA COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:TOMERIAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-492-1981
Mailing Address - Street 1:2500 ALUMNI DR APT 12104
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3949
Mailing Address - Country:US
Mailing Address - Phone:859-492-1981
Mailing Address - Fax:
Practice Address - Street 1:1500 LEESTOWN RD STE 306
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-2044
Practice Address - Country:US
Practice Address - Phone:859-492-1981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252202261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health