MEDICARE: MICHELLE CATHERINE BROOTEN-BROOKS M.S., LMFT

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	106H00000X	Marriage & Family Therapist	MFT001828	GA

General Provider Information

NPI Number	:	1720619844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE CATHERINE BROOTEN-BROOKS M.S., LMFT

Provider Business Mailing Address
First Line	:	100 N PATTERSON ST STE 60
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31601-5570
Country	:	US
Telephone Number	:	770-750-5638
Fax Number	:	888-388-0456

Provider Business Practice Location Address
First Line	:	100 N PATTERSON ST STE 60
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31601-5570
Country	:	US
Telephone Number	:	770-750-5638
Fax Number	:	888-388-0456

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

Provider Enumeration Date	:	01/28/2020
Last Update Date	:	12/11/2023

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