Provider Demographics
NPI:1184612418
Name:BROOKS, BARRY G (PHD, LCPC)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:G
Last Name:BROOKS
Suffix:
Gender:
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N MIDLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-1747
Mailing Address - Country:US
Mailing Address - Phone:208-615-1313
Mailing Address - Fax:208-960-1775
Practice Address - Street 1:1016 W SANETTA ST
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-5047
Practice Address - Country:US
Practice Address - Phone:208-615-1313
Practice Address - Fax:208-960-1775
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC29101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional