Provider Demographics
NPI:1013626803
Name:BROOKS, ALTHEA RENEE
Entity Type:Individual
Prefix:
First Name:ALTHEA
Middle Name:RENEE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5134 CLEAR SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-5584
Mailing Address - Country:US
Mailing Address - Phone:580-743-2265
Mailing Address - Fax:
Practice Address - Street 1:1510 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4333
Practice Address - Country:US
Practice Address - Phone:580-255-3926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator