Provider Demographics
NPI:1578605317
Name:BROOKE, AMY LOUISE (LCPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:BROOKE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 E SHELBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-4923
Mailing Address - Country:US
Mailing Address - Phone:309-826-8140
Mailing Address - Fax:309-826-8140
Practice Address - Street 1:925 E SHELBOURNE DR
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-4923
Practice Address - Country:US
Practice Address - Phone:309-826-8140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006163101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional