Provider Demographics
NPI:1417250903
Name:CHILES, BROOKE ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:ELIZABETH
Last Name:CHILES
Suffix:
Gender:F
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 1335
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-1335
Mailing Address - Country:US
Mailing Address - Phone:918-649-0772
Mailing Address - Fax:918-649-7701
Practice Address - Street 1:900 N BROADWAY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-2617
Practice Address - Country:US
Practice Address - Phone:918-649-0772
Practice Address - Fax:918-649-0771
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor