Provider Demographics
NPI:1679990014
Name:BROOKS, RANDAL (LPC)
Entity Type:Individual
Prefix:
First Name:RANDAL
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1528
Mailing Address - Street 2:
Mailing Address - City:CORTARO
Mailing Address - State:AZ
Mailing Address - Zip Code:85652-1528
Mailing Address - Country:US
Mailing Address - Phone:520-403-4763
Mailing Address - Fax:520-795-0817
Practice Address - Street 1:4320 N CAMPBELL AVE
Practice Address - Street 2:SUITE 226
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6584
Practice Address - Country:US
Practice Address - Phone:520-403-4763
Practice Address - Fax:520-795-0817
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10402101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional