Provider Demographics
NPI:1972184828
Name:BROOKOVER, LUANNE CAROL (LPC)
Entity Type:Individual
Prefix:
First Name:LUANNE
Middle Name:CAROL
Last Name:BROOKOVER
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 1:28843 N SADDLE WAY
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-4968
Mailing Address - Country:US
Mailing Address - Phone:148-056-0774
Mailing Address - Fax:
Practice Address - Street 1:28843 N SADDLE WAY
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85143-4968
Practice Address - Country:US
Practice Address - Phone:148-056-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-18039101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86-3312149Medicaid