Provider Demographics
NPI:1407327059
Name:BROOKS, KELLY MICHELLE (LCSW S)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MICHELLE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LCSW S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 BROOKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1207
Mailing Address - Country:US
Mailing Address - Phone:254-913-0594
Mailing Address - Fax:
Practice Address - Street 1:317 N 2ND ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76501-3216
Practice Address - Country:US
Practice Address - Phone:254-298-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX506851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical