Provider Demographics
NPI:1972199099
Name:BROOKHAVEN COUNSELING GROUP, LLC
Entity Type:Organization
Organization Name:BROOKHAVEN COUNSELING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND LEAD THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MEREDYTH
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOK
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:476-520-0902
Mailing Address - Street 1:2209 W WINONA ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1831
Mailing Address - Country:US
Mailing Address - Phone:847-652-0902
Mailing Address - Fax:
Practice Address - Street 1:2209 W WINONA ST UNIT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1831
Practice Address - Country:US
Practice Address - Phone:847-652-0902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-13
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty