Provider Demographics
NPI:1558500223
Name:DAVID M BROOKS PHD PSYCHOLOGICAL SERVICES PC
Entity Type:Organization
Organization Name:DAVID M BROOKS PHD PSYCHOLOGICAL SERVICES PC
Other - Org Name:DAVID M BROOKS PHD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-498-0555
Mailing Address - Street 1:6404 WILSHIRE BLVD
Mailing Address - Street 2:STE 1030
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5501
Mailing Address - Country:US
Mailing Address - Phone:310-498-0555
Mailing Address - Fax:323-647-3159
Practice Address - Street 1:6404 WILSHIRE BLVD
Practice Address - Street 2:STE 1030
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5501
Practice Address - Country:US
Practice Address - Phone:310-498-0555
Practice Address - Fax:323-647-3159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20877103TC0700X, 103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysisGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ56245YOtherBLUE SHIELD OF CALIFORNIA
CA1174503403OtherCIGNA HEALTHCARE/CBH
CA1174503403OtherUNITED BEHAVIORAL HEALTH
CA=========OtherAETNA
CAZZZ56245YOtherBLUE SHIELD OF CALIFORNIA