Provider Demographics
NPI:1366640336
Name:BROOKS, JUDITH M (MFT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:M
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 W LUTGE AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-3322
Mailing Address - Country:US
Mailing Address - Phone:818-395-3925
Mailing Address - Fax:818-566-6606
Practice Address - Street 1:336 W LUTGE AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-3322
Practice Address - Country:US
Practice Address - Phone:818-395-3925
Practice Address - Fax:818-566-6606
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31299101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA31299OtherBOARD OF BEHAVIORAL SCIEN