Provider Demographics
NPI:1427575034
Name:STEVEN BROOKS PC
Entity Type:Organization
Organization Name:STEVEN BROOKS PC
Other - Org Name:STEVEN BROOKS PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LLP
Authorized Official - Phone:810-278-6693
Mailing Address - Street 1:1133 S STATE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1963
Mailing Address - Country:US
Mailing Address - Phone:810-278-6693
Mailing Address - Fax:810-652-6263
Practice Address - Street 1:1133 S STATE RD STE 5
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1963
Practice Address - Country:US
Practice Address - Phone:810-278-6693
Practice Address - Fax:810-652-6263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007639103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty