Provider Demographics
NPI:1457781346
Name:BROOKE, HEATHER (LPC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BROOKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 BUCK RIDGE CV
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-9699
Mailing Address - Country:US
Mailing Address - Phone:719-480-1525
Mailing Address - Fax:
Practice Address - Street 1:26112 W US HWY 160
Practice Address - Street 2:
Practice Address - City:SOUTH FORK
Practice Address - State:CO
Practice Address - Zip Code:81154-0001
Practice Address - Country:US
Practice Address - Phone:719-480-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012680101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional