Provider Demographics
NPI:1972051399
Name:BROOKS, RUBY DENISE (MFT-A)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:DENISE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1927
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-1927
Mailing Address - Country:US
Mailing Address - Phone:502-637-4361
Mailing Address - Fax:502-637-4490
Practice Address - Street 1:841 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1014
Practice Address - Country:US
Practice Address - Phone:502-637-4361
Practice Address - Fax:502-587-7145
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 106H00000X
KY175441106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)