Provider Demographics
NPI:1811785942
Name:BROOKS, ELISA BJORG
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:BJORG
Last Name:BROOKS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 SE 9TH AVE APT 601
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2293
Mailing Address - Country:US
Mailing Address - Phone:619-818-7767
Mailing Address - Fax:
Practice Address - Street 1:1730 SW SKYLINE BLVD STE 109
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2547
Practice Address - Country:US
Practice Address - Phone:971-203-2326
Practice Address - Fax:971-203-2572
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist