Provider Demographics
NPI:1760600480
Name:BROOKE, KARLAINA MATTHEWS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KARLAINA
Middle Name:MATTHEWS
Last Name:BROOKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 SE SANDY BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2498
Mailing Address - Country:US
Mailing Address - Phone:503-893-4419
Mailing Address - Fax:
Practice Address - Street 1:975 SE SANDY BLVD STE 160
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2498
Practice Address - Country:US
Practice Address - Phone:503-893-4419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003079103TC0700X
OR1623103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
201893768OtherTAX ID NUMBER