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
State | License ID | Taxonomies |
---|---|---|
MI | 6301002506 | 103TC0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Single Specialty |