Provider Demographics
NPI:1740781756
Name:RYCHLIK, BROOK DANIELLE
Entity Type:Individual
Prefix:
First Name:BROOK
Middle Name:DANIELLE
Last Name:RYCHLIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22727 DETOUR ST
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082
Mailing Address - Country:US
Mailing Address - Phone:586-914-2193
Mailing Address - Fax:
Practice Address - Street 1:13213 E 14 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-6302
Practice Address - Country:US
Practice Address - Phone:586-939-4374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-24
Last Update Date:2018-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool