Provider Demographics
NPI:1245993542
Name:GAMBRELL, BROOKE NICOLE (BA MA RBT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:NICOLE
Last Name:GAMBRELL
Suffix:
Gender:
Credentials:BA MA RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9424 CHAPMANS BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-9111
Mailing Address - Country:US
Mailing Address - Phone:260-494-0423
Mailing Address - Fax:
Practice Address - Street 1:7561 W JEFFERSON BLVD
Practice Address - Street 2:GOLDEN STEPS
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804
Practice Address - Country:US
Practice Address - Phone:260-494-0423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician