Provider Demographics
NPI:1508223553
Name:MCMAKEN, BROOKE (LMHC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:MCMAKEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 BID A WEE LN
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-2761
Mailing Address - Country:US
Mailing Address - Phone:303-618-5614
Mailing Address - Fax:
Practice Address - Street 1:415 N RICHARD JACKSON BLVD STE 206B
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-3694
Practice Address - Country:US
Practice Address - Phone:303-618-5614
Practice Address - Fax:850-248-2469
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14001101YM0800X
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health