Provider Demographics
NPI:1700359379
Name:BROOKS, DONNA L
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 METRO DR STE B
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71109-6001
Mailing Address - Country:US
Mailing Address - Phone:318-636-0391
Mailing Address - Fax:318-635-3298
Practice Address - Street 1:4111 METRO DR STE B
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109-6001
Practice Address - Country:US
Practice Address - Phone:318-636-0391
Practice Address - Fax:318-635-3298
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral