Provider Demographics
NPI:1417276734
Name:BROOKS, LANNY DON (MED, LPC)
Entity Type:Individual
Prefix:MR
First Name:LANNY
Middle Name:DON
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 DEVONSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5721
Mailing Address - Country:US
Mailing Address - Phone:405-341-5465
Mailing Address - Fax:405-341-5465
Practice Address - Street 1:1400 DEVONSHIRE CT
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5721
Practice Address - Country:US
Practice Address - Phone:405-341-5465
Practice Address - Fax:405-341-5465
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1487101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1487OtherLICENSED PROFESSIONAL COUNSELOR