Provider Demographics
NPI:1659458255
Name:L. P. BROOKS, ED.D., PLLC
Entity type:Organization
Organization Name:L. P. BROOKS, ED.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name::LOIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:231-972-5249
Mailing Address - Street 1:6977 ABBEY LN
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49346-8994
Mailing Address - Country:US
Mailing Address - Phone:231-972-5249
Mailing Address - Fax:
Practice Address - Street 1:6977 ABBEY LN
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:MI
Practice Address - Zip Code:49346-8994
Practice Address - Country:US
Practice Address - Phone:231-972-5249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002506103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty