MEDICARE: ADAM BROOKSHIRE

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	1041C0700X	Clinical Social Worker
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1346518206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM BROOKSHIRE

Provider Business Mailing Address
First Line	:	9580 W RENO AVE UNIT 226
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1713
Country	:	US
Telephone Number	:	702-580-7743
Fax Number	:

Provider Business Practice Location Address
First Line	:	9580 W RENO AVE UNIT 226
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1713
Country	:	US
Telephone Number	:	702-580-7743
Fax Number	:

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

Provider Enumeration Date	:	12/07/2011
Last Update Date	:	12/07/2011

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Directions to “ ADAM BROOKSHIRE ” Practice Location

Language	Start Address	Practice Location

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