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NPI Code Detail

MEDICARE: DR. REBECCA PRATHER BROOKS PH.D.

MEDICARE: DR. REBECCA PRATHER BROOKS PH.D.
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
1103T00000XPsychologistPY01839MO
2103TH0100XHealth Service PsychologistPY8967FL

General Provider Information

NPI Number : 1851387963
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. REBECCA PRATHER BROOKS PH.D.
Provider Business Mailing Address
First Line : 2746 GULF BREEZE PKWY
Second Line : SUITE B
City : GULF BREEZE
State : FL
Zip : 32563-3091
Country : US
Telephone Number : 850-932-2746
Fax Number :
Provider Business Practice Location Address
First Line : 2746 GULF BREEZE PKWY
Second Line : SUITE B
City : GULF BREEZE
State : FL
Zip : 32563-3091
Country : US
Telephone Number : 850-932-2746
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2005
Last Update Date : 10/19/2015

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