Provider Demographics
NPI:1982311536
Name:BROOKLONG COMPASSIONS LLC
Entity Type:Organization
Organization Name:BROOKLONG COMPASSIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER IN CHARGE/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:816-507-6002
Mailing Address - Street 1:3122 BRYN MAWR DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2689
Mailing Address - Country:US
Mailing Address - Phone:816-507-6002
Mailing Address - Fax:
Practice Address - Street 1:3122 BRYN MAWR DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2689
Practice Address - Country:US
Practice Address - Phone:816-507-6002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)