Provider Demographics
NPI:1639869928
Name:BROOKS, STEPHAN (DHSC, MPH, CHES)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DHSC, MPH, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HAGER ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-5814
Mailing Address - Country:US
Mailing Address - Phone:304-906-9708
Mailing Address - Fax:
Practice Address - Street 1:111 HAGER ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-5814
Practice Address - Country:US
Practice Address - Phone:304-906-9708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV30708174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator