Provider Demographics
NPI:1720619844
Name:BROOTEN-BROOKS, MICHELLE CATHERINE (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CATHERINE
Last Name:BROOTEN-BROOKS
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N PATTERSON ST STE 60
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-5570
Mailing Address - Country:US
Mailing Address - Phone:770-750-5638
Mailing Address - Fax:888-388-0456
Practice Address - Street 1:100 N PATTERSON ST STE 60
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-5570
Practice Address - Country:US
Practice Address - Phone:770-750-5638
Practice Address - Fax:888-388-0456
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001828106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist