Provider Demographics
NPI:1669855425
Name:COOK, BROOKLYN ELISE (ACMHC, NCC)
Entity Type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:ELISE
Last Name:COOK
Suffix:
Gender:F
Credentials:ACMHC, NCC
Other - Prefix:
Other - First Name:BROOKLYN
Other - Middle Name:ELISE
Other - Last Name:REBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2460 W 450 S APT 3
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-4938
Mailing Address - Country:US
Mailing Address - Phone:678-860-0233
Mailing Address - Fax:
Practice Address - Street 1:3549 N UNIVERSITY AVE STE 200
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4417
Practice Address - Country:US
Practice Address - Phone:801-377-2014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT17793386-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health