MEDICARE: BROOKS BEHAVIORAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	101YP1600X	Pastoral Counselor
4	101YS0200X	School Counselor
5	106S00000X	Behavior Technician
6	251B00000X	Case Management Agency
7	251S00000X	Community/Behavioral Health Agency
8	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1912548991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKS BEHAVIORAL LLC

Provider Business Mailing Address
First Line	:	520 SW ATLAS DR
Second Line	:
City	:	FORT WHITE
State	:	FL
Zip	:	32038-2430
Country	:	US
Telephone Number	:	352-497-9719
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 NW 23RD AVE STE D
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32609-3449
Country	:	US
Telephone Number	:	352-339-5848
Fax Number	:	352-240-3919

Authorized Official
Title or Position	:	OPERATIONS DIRECTOR
Name	:	NANCY LOUNSBURY
Credential	:
Telephone Number	:	386-454-0660

Provider Enumeration Date	:	10/01/2019
Last Update Date	:	01/28/2023

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