Provider Demographics
NPI:1497077705
Name:BROOKS, MARY SHANNON (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SHANNON
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 TURTLE CREEK BLVD APT 246
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-4256
Mailing Address - Country:US
Mailing Address - Phone:512-797-0976
Mailing Address - Fax:
Practice Address - Street 1:2525 WALLINGWOOD DR STE 700
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6929
Practice Address - Country:US
Practice Address - Phone:512-797-0976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-28
Last Update Date:2010-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17116101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional