Provider Demographics
NPI:1629571369
Name:BROOKS, CHANELLE MARIE (BCBA)
Entity Type:Individual
Prefix:
First Name:CHANELLE
Middle Name:MARIE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 NOHEA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5331
Mailing Address - Country:US
Mailing Address - Phone:808-430-4394
Mailing Address - Fax:
Practice Address - Street 1:40 NOHEA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5331
Practice Address - Country:US
Practice Address - Phone:808-430-4394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst