Provider Demographics
NPI:1265701668
Name:JOHNSON, BROOKS THOMAS (LMHC)
Entity type:Individual
Prefix:MR
First Name:BROOKS
Middle Name:THOMAS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1637
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34284-1637
Mailing Address - Country:US
Mailing Address - Phone:850-877-4228
Mailing Address - Fax:888-700-6760
Practice Address - Street 1:1310 CROSS CREEK CIR
Practice Address - Street 2:SUITE A
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-8062
Practice Address - Country:US
Practice Address - Phone:850-294-0695
Practice Address - Fax:888-700-6760
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9403101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health