Provider Demographics
NPI: | 1376698274 |
---|---|
Name: | MICHELE MYRUS-BROOKS |
Entity Type: | Organization |
Organization Name: | MICHELE MYRUS-BROOKS |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SCHOOL PSYCHOLOGIST |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | MICHELE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MYRUS-BROOKS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | EDS,NCSP |
Authorized Official - Phone: | 520-682-4782 |
Mailing Address - Street 1: | 4156 E CALLE MARFIL |
Mailing Address - Street 2: | |
Mailing Address - City: | TUCSON |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85712-6409 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 520-299-8359 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 11279 W GRIER RD |
Practice Address - Street 2: | |
Practice Address - City: | MARANA |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85653-9609 |
Practice Address - Country: | US |
Practice Address - Phone: | 520-682-4782 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-01-24 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | 103TS0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103TS0200X | Behavioral Health & Social Service Providers | Psychologist | School | Group - Multi-Specialty |