Provider Demographics
NPI:1639207061
Name:BROOKS, LUCY MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:MARIE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 PARK GROTON PL
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-2519
Mailing Address - Country:US
Mailing Address - Phone:408-206-4808
Mailing Address - Fax:
Practice Address - Street 1:17705 HALE AVE
Practice Address - Street 2:SUITE H-5
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4340
Practice Address - Country:US
Practice Address - Phone:408-960-4039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT83933106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health