Provider Demographics
NPI:1437391836
Name:BROOKS, PRUEDENCE C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PRUEDENCE
Middle Name:C
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S DAIRY ASHFORD RD STE 380
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-5733
Mailing Address - Country:US
Mailing Address - Phone:281-741-2210
Mailing Address - Fax:281-741-9734
Practice Address - Street 1:2000 S DAIRY ASHFORD RD STE 380
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-5733
Practice Address - Country:US
Practice Address - Phone:281-741-2210
Practice Address - Fax:281-741-9734
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33885103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2003766-05Medicaid
TX2003766-02Medicaid