Provider Demographics
NPI:1619543139
Name:BROOKS, KYLE ALLEN
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:ALLEN
Last Name:BROOKS
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 1:528 E MAIN ST STE W
Mailing Address - Street 2:
Mailing Address - City:JOHN DAY
Mailing Address - State:OR
Mailing Address - Zip Code:97845-1289
Mailing Address - Country:US
Mailing Address - Phone:541-575-1466
Mailing Address - Fax:
Practice Address - Street 1:528 E MAIN ST STE W
Practice Address - Street 2:
Practice Address - City:JOHN DAY
Practice Address - State:OR
Practice Address - Zip Code:97845-1289
Practice Address - Country:US
Practice Address - Phone:541-575-1466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health