Provider Demographics
NPI:1407501372
Name:BROOKS, PAUL THOMAS
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:THOMAS
Last Name:BROOKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15
Mailing Address - Street 2:
Mailing Address - City:ARCHER CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76351-0015
Mailing Address - Country:US
Mailing Address - Phone:940-249-6578
Mailing Address - Fax:
Practice Address - Street 1:408 WEST SOUTH STREET
Practice Address - Street 2:
Practice Address - City:ARCHER CITY
Practice Address - State:TX
Practice Address - Zip Code:76351
Practice Address - Country:US
Practice Address - Phone:940-249-6578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63366101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional