Provider Demographics
NPI:1598222333
Name:RUBLE, BROOK (LPC)
Entity Type:Individual
Prefix:
First Name:BROOK
Middle Name:
Last Name:RUBLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 HIGHWAY 84 W
Mailing Address - Street 2:
Mailing Address - City:CARUTHERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63830-8113
Mailing Address - Country:US
Mailing Address - Phone:573-333-5875
Mailing Address - Fax:
Practice Address - Street 1:915 HIGHWAY 84 W
Practice Address - Street 2:
Practice Address - City:CARUTHERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63830-8113
Practice Address - Country:US
Practice Address - Phone:573-333-5875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional