MEDICARE: MS. MELINDA KAYE BROOKMAN B.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073652319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELINDA KAYE BROOKMAN B.S.

Provider Business Mailing Address
First Line	:	9041 EXECUTIVE PARK DR STE 275B
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4621
Country	:	US
Telephone Number	:	865-338-5384
Fax Number	:	865-338-5383

Provider Business Practice Location Address
First Line	:	9041 EXECUTIVE PARK DR STE 275B
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4621
Country	:	US
Telephone Number	:	865-338-5384
Fax Number	:	865-338-5383

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	04/04/2024

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