Provider Demographics
NPI:1003455734
Name:BROOKS, RANDLE KATHERINE (LPCC)
Entity type:Individual
Prefix:
First Name:RANDLE
Middle Name:KATHERINE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 COUNTY ROAD 513
Mailing Address - Street 2:
Mailing Address - City:IGNACIO
Mailing Address - State:CO
Mailing Address - Zip Code:81137-9719
Mailing Address - Country:US
Mailing Address - Phone:903-517-4595
Mailing Address - Fax:
Practice Address - Street 1:2855 MAIN AVE STE A105
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5959
Practice Address - Country:US
Practice Address - Phone:903-517-4595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-28
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0021193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health