Provider Demographics
NPI:1669041604
Name:SPLAIN, BROOKE (CMHC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:SPLAIN
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1848 E PEYTON CT
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5654
Mailing Address - Country:US
Mailing Address - Phone:310-213-1044
Mailing Address - Fax:
Practice Address - Street 1:740 E 9000 S STE A
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3077
Practice Address - Country:US
Practice Address - Phone:801-930-0121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11841969-6009101YM0800X
UT11841969-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health