Provider Demographics
NPI:1578248076
Name:WILKINS, BROOKE LYNN (CADC CANDIDATE)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:LYNN
Last Name:WILKINS
Suffix:
Gender:F
Credentials:CADC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 E CHEROKEE AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5323
Mailing Address - Country:US
Mailing Address - Phone:918-423-9400
Mailing Address - Fax:
Practice Address - Street 1:32 E CHEROKEE AVE STE 104
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5323
Practice Address - Country:US
Practice Address - Phone:918-423-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator