Provider Demographics
NPI:1629639992
Name:MCBROOM, ALAN LEROY (ASWCM)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:LEROY
Last Name:MCBROOM
Suffix:
Gender:M
Credentials:ASWCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24681 NORTHWESTERN HWY STE 307
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2322
Mailing Address - Country:US
Mailing Address - Phone:248-355-1980
Mailing Address - Fax:248-355-0362
Practice Address - Street 1:24681 NORTHWESTERN HWY
Practice Address - Street 2:STE 3001
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2305
Practice Address - Country:US
Practice Address - Phone:248-355-1980
Practice Address - Fax:248-355-0362
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801015680104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker