Provider Demographics
NPI:1497860092
Name:BROOKS, WILLIAM DOUGLAS (EDD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DOUGLAS
Last Name:BROOKS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-3224
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4415 DUKE ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3224
Practice Address - Country:US
Practice Address - Phone:269-349-1799
Practice Address - Fax:269-349-1820
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2557103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling