Provider Demographics
NPI:1508821380
Name:BROOKS, KATHRYN (PHD, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W KING ST
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-1212
Mailing Address - Country:US
Mailing Address - Phone:717-658-5626
Mailing Address - Fax:717-532-9308
Practice Address - Street 1:20 W KING ST
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-1212
Practice Address - Country:US
Practice Address - Phone:717-658-5626
Practice Address - Fax:717-532-9308
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000376101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA536056OtherVALUE OPTIONS
PA50042765OtherCAPITAL BLUE CROSS
PA810554001OtherTEAM
PA239717OtherCOMPSYCH
PA341996OtherMHNET-TRICARE
PA001959469OtherCOMMUNITY BEHAVIORAL HEAL