Provider Demographics
NPI:1518449602
Name:BROOKE RUXTON PHD LLC
Entity Type:Organization
Organization Name:BROOKE RUXTON PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUXTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:515-508-9992
Mailing Address - Street 1:2385 STOUGHTON CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-6478
Mailing Address - Country:US
Mailing Address - Phone:515-508-9992
Mailing Address - Fax:
Practice Address - Street 1:2385 STOUGHTON CIR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-6478
Practice Address - Country:US
Practice Address - Phone:515-508-9992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007643261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)