Provider Demographics
NPI:1417365727
Name:SWISHER, BROOKE E (MA, LPC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:E
Last Name:SWISHER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 S 105TH PL APT 2063
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3846
Mailing Address - Country:US
Mailing Address - Phone:602-303-1882
Mailing Address - Fax:
Practice Address - Street 1:1304 S 105TH PL APT 2063
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3846
Practice Address - Country:US
Practice Address - Phone:602-303-1882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-15273101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional