Provider Demographics
NPI:1750559118
Name:BROOKS, DAVID RANDALL (BSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RANDALL
Last Name:BROOKS
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 N 3RD AVE STE E
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-4244
Mailing Address - Country:US
Mailing Address - Phone:405-527-9562
Mailing Address - Fax:405-360-4918
Practice Address - Street 1:129 N 3RD AVE STE E
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-4244
Practice Address - Country:US
Practice Address - Phone:405-527-9562
Practice Address - Fax:405-360-4918
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)