Provider Demographics
NPI:1437577616
Name:REBECCA PRATHER BROOKS, PHD, LLC
Entity Type:Organization
Organization Name:REBECCA PRATHER BROOKS, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:PRATHER
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:816-309-5211
Mailing Address - Street 1:2746 GULF BREEZE PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3091
Mailing Address - Country:US
Mailing Address - Phone:850-932-2746
Mailing Address - Fax:
Practice Address - Street 1:2746 GULF BREEZE PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3091
Practice Address - Country:US
Practice Address - Phone:850-932-2746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01839103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1851387963OtherPERSONAL NPI
1851387963OtherPERSONAL NPI