Provider Demographics
NPI:1982217428
Name:BROOKS, AUGUSTA I (LPC)
Entity Type:Individual
Prefix:
First Name:AUGUSTA
Middle Name:I
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:R353 COUNTY ROAD 6C
Mailing Address - Street 2:
Mailing Address - City:LIBERTY CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43532-9558
Mailing Address - Country:US
Mailing Address - Phone:567-280-2602
Mailing Address - Fax:
Practice Address - Street 1:2211 RIVER RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-3637
Practice Address - Country:US
Practice Address - Phone:419-740-3052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC2002582-TRNE101YM0800X
OHC.2204266101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health