Provider Demographics
NPI:1881189488
Name:BROOKS, JACLYN DENISE (MHS)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:DENISE
Last Name:BROOKS
Suffix:
Gender:
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 NOLAN TRCE STE B
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-3838
Mailing Address - Country:US
Mailing Address - Phone:318-404-7731
Mailing Address - Fax:
Practice Address - Street 1:1112 NOLAN TRCE # B
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-3838
Practice Address - Country:US
Practice Address - Phone:337-404-7131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor