Provider Demographics
NPI:1720356371
Name:STEPHENS, BROOKE NACOLE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:NACOLE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 LENOX PL
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-7520
Mailing Address - Country:US
Mailing Address - Phone:423-215-8497
Mailing Address - Fax:
Practice Address - Street 1:416 LENOX PL
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-7520
Practice Address - Country:US
Practice Address - Phone:423-215-8497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-11
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1492106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist