Provider Demographics
NPI:1821461351
Name:BROOKS, CHARNELL JAVETTE (LPC)
Entity Type:Individual
Prefix:
First Name:CHARNELL
Middle Name:JAVETTE
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 1:1829 EMBERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5159
Mailing Address - Country:US
Mailing Address - Phone:318-436-1844
Mailing Address - Fax:318-584-6140
Practice Address - Street 1:608 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-4758
Practice Address - Country:US
Practice Address - Phone:318-436-1844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5454101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional