Provider Demographics
NPI:1568405116
Name:BROOKE, MELODY (LPC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:MELODY
Middle Name:
Last Name:BROOKE
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 STANFORD LN
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-2967
Mailing Address - Country:US
Mailing Address - Phone:469-223-7153
Mailing Address - Fax:
Practice Address - Street 1:1221 W CAMPBELL RD
Practice Address - Street 2:SUITE 271
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2967
Practice Address - Country:US
Practice Address - Phone:469-223-7153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11038101YP2500X
TX4400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist