Provider Demographics
NPI:1851737670
Name:BROOKS, PAMELA
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:BROOKS
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 1:765 W LIMBERLOST DR
Mailing Address - Street 2:#5
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1564
Mailing Address - Country:US
Mailing Address - Phone:520-312-2625
Mailing Address - Fax:
Practice Address - Street 1:765 W LIMBERLOST DR
Practice Address - Street 2:#5
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1564
Practice Address - Country:US
Practice Address - Phone:520-312-2625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4515175385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4515175OtherPROFESSIONAL FOSTER CARE LICENSE