Provider Demographics
NPI:1619499324
Name:BROOKENS, MATTHEW PAHL
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PAHL
Last Name:BROOKENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3834
Mailing Address - Country:US
Mailing Address - Phone:503-806-5276
Mailing Address - Fax:
Practice Address - Street 1:1823 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3834
Practice Address - Country:US
Practice Address - Phone:503-806-5276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor