MEDICARE: BROOKLEA COUNSELING & HEALTH SERVICES

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	101Y00000X	Counselor	10294	TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558426585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKLEA COUNSELING & HEALTH SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 1481
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-1481
Country	:	US
Telephone Number	:	214-883-1226
Fax Number	:	972-429-1901

Provider Business Practice Location Address
First Line	:	900 E PARK BLVD
Second Line	:	SUITE 155
City	:	PLANO
State	:	TX
Zip	:	75074-5465
Country	:	US
Telephone Number	:	214-883-1226
Fax Number	:	972-429-1901

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. LENA BENTON
Credential	:	LPC, RN
Telephone Number	:	214-883-1226

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/08/2011

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Directions to “BROOKLEA COUNSELING & HEALTH SERVICES ” Practice Location

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