MEDICARE: MR. PHILLIP JAY BROOKS LMHC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	MH3098	FL
2	101YM0800X	Mental Health Counselor	MH3098	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MH 3098	OTHER	FL	LICENSED MH COUNSELOR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093789836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILLIP JAY BROOKS LMHC

Provider Business Mailing Address
First Line	:	705 DEAN AVENUE
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34237
Country	:	US
Telephone Number	:	941-953-4318
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 17TH ST
Second Line	:	BLDG J-2
City	:	SARASOTA
State	:	FL
Zip	:	34234-8632
Country	:	US
Telephone Number	:	941-552-2078
Fax Number	:	941-552-2079

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

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	01/11/2011

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