Provider Demographics
NPI:1487223103
Name:BROOKHART, DEANNA MARIE (PHD, LCPC, CAADC)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:MARIE
Last Name:BROOKHART
Suffix:
Gender:F
Credentials:PHD, LCPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 N FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-2531
Mailing Address - Country:US
Mailing Address - Phone:618-553-8380
Mailing Address - Fax:
Practice Address - Street 1:1506 N FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-2531
Practice Address - Country:US
Practice Address - Phone:618-553-8380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003683101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health