Provider Demographics
NPI:1659822724
Name:TREADWELL-BROOKES, ELIZABETH ANNE (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:TREADWELL-BROOKES
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 BRITTAIN ROAD
Mailing Address - Street 2:PO BOX 93
Mailing Address - City:TROY
Mailing Address - State:VT
Mailing Address - Zip Code:05868
Mailing Address - Country:US
Mailing Address - Phone:802-272-6648
Mailing Address - Fax:
Practice Address - Street 1:29 COLFAX ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-5511
Practice Address - Country:US
Practice Address - Phone:802-272-6648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0110712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health