Provider Demographics
NPI:1790839934
Name:BROOKS, DAVID A (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:BROOKS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N 14TH ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0697
Mailing Address - Country:US
Mailing Address - Phone:701-401-5342
Mailing Address - Fax:701-751-3947
Practice Address - Street 1:3000 N 14TH ST STE 3A
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0697
Practice Address - Country:US
Practice Address - Phone:701-401-5342
Practice Address - Fax:701-751-3947
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND278103G00000X, 103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1452643Medicaid
ND1452643Medicaid
NDN13248Medicare PIN
NDR34428Medicare UPIN
ND18618Medicaid