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NPI Code Detail

MEDICARE: PHILLIP BROOKS

MEDICARE: PHILLIP BROOKS
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1265812390
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILLIP BROOKS
Provider Business Mailing Address
First Line : 2834 SOLANO DEL SOL DR NE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87144-0574
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8500 WASHINGTON ST NE STE A1
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87113-1861
Country : US
Telephone Number : 505-515-9959
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2015
Last Update Date : 06/03/2015

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Directions to “ PHILLIP BROOKS ” Practice Location

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