Provider Demographics
NPI:1629513122
Name:STORM, BROOKE (LIMHP)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:
Last Name:STORM
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10866 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NEBRASKA
Mailing Address - Zip Code:68164
Mailing Address - Country:UM
Mailing Address - Phone:402-614-9092
Mailing Address - Fax:
Practice Address - Street 1:10866 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-1242
Practice Address - Country:US
Practice Address - Phone:402-979-4577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10797101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health