Provider Demographics
NPI:1811290117
Name:PRUEDENCE BROOKS, PSYD, PLLC
Entity type:Organization
Organization Name:PRUEDENCE BROOKS, PSYD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PRUEDENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:281-741-2210
Mailing Address - Street 1:2000 S DAIRY ASHFORD RD STE 380
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-5733
Mailing Address - Country:US
Mailing Address - Phone:281-741-2210
Mailing Address - Fax:281-741-9734
Practice Address - Street 1:2000 S DAIRY ASHFORD RD STE 380
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-5733
Practice Address - Country:US
Practice Address - Phone:281-741-2210
Practice Address - Fax:281-741-9734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33885103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2003766-02Medicaid
TX2003766-02Medicaid