MEDICARE: LINDA BROOKS, LLC

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	5787-S	NV

General Provider Information

NPI Number	:	1609272285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINDA BROOKS, LLC

Provider Business Mailing Address
First Line	:	5145 S DURANGO DR
Second Line	:	SUITE 104
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-0191
Country	:	US
Telephone Number	:	702-595-3888
Fax Number	:

Provider Business Practice Location Address
First Line	:	5145 S DURANGO DR
Second Line	:	SUITE 104
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-0191
Country	:	US
Telephone Number	:	702-595-3888
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LINDA BROOKS
Credential	:	LCSW
Telephone Number	:	702-595-3888

Provider Enumeration Date	:	11/10/2014
Last Update Date	:	11/10/2014

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