Provider Demographics
NPI:1639948359
Name:CRISP, BROOKE WEST (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:WEST
Last Name:CRISP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SALADO
Mailing Address - State:TX
Mailing Address - Zip Code:76571-6462
Mailing Address - Country:US
Mailing Address - Phone:254-913-8058
Mailing Address - Fax:
Practice Address - Street 1:511 CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:SALADO
Practice Address - State:TX
Practice Address - Zip Code:76571-6462
Practice Address - Country:US
Practice Address - Phone:737-290-9737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health