Provider Demographics
NPI:1770935470
Name:BROOKS, MARY (LMSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:J
Other - Last Name:WREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:934 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3838
Mailing Address - Country:US
Mailing Address - Phone:316-660-7600
Mailing Address - Fax:316-941-5075
Practice Address - Street 1:1919 N AMIDON AVE
Practice Address - Street 2:STE 130
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2117
Practice Address - Country:US
Practice Address - Phone:316-660-7675
Practice Address - Fax:316-832-1571
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10036104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker