Provider Demographics
NPI:1760625693
Name:BROOKS, LAURA K (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:K
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6273 VISTA VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:63051-4339
Mailing Address - Country:US
Mailing Address - Phone:314-312-2622
Mailing Address - Fax:
Practice Address - Street 1:14615 MANCHESTER RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-3790
Practice Address - Country:US
Practice Address - Phone:314-312-2622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.004232101YP2500X
MO2007025815101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional