Provider Demographics
NPI:1720735855
Name:BROOKE, HALINA M (LAMFT, LAC)
Entity Type:Individual
Prefix:
First Name:HALINA
Middle Name:M
Last Name:BROOKE
Suffix:
Gender:F
Credentials:LAMFT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16421 N TATUM BLVD STE 122
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3455
Mailing Address - Country:US
Mailing Address - Phone:602-787-0600
Mailing Address - Fax:
Practice Address - Street 1:16421 N TATUM BLVD STE 122
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3455
Practice Address - Country:US
Practice Address - Phone:602-787-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-20493101Y00000X
AZLAMFT-10816106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor