Provider Demographics
NPI:1639821903
Name:BROOKS PSYCHOTHERAPY PC
Entity Type:Organization
Organization Name:BROOKS PSYCHOTHERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-225-1871
Mailing Address - Street 1:30665 NORTHWESTERN HWY STE 255
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3144
Mailing Address - Country:US
Mailing Address - Phone:248-225-1871
Mailing Address - Fax:248-550-0287
Practice Address - Street 1:30665 NORTHWESTERN HWY STE 255
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3144
Practice Address - Country:US
Practice Address - Phone:248-225-1871
Practice Address - Fax:248-550-0287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty