Healthcare Provider Details

I. General information

NPI: 1053461442
Provider Name (Legal Business Name): BRETT B BROCKETT LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 10/08/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MEDICAL DR
DOTHAN AL
36303-6903
US

IV. Provider business mailing address

101 MEDICAL DR.
DOTHAN AL
36303
US

V. Phone/Fax

Practice location:
  • Phone: 334-702-7222
  • Fax: 334-702-1944
Mailing address:
  • Phone: 334-702-7222
  • Fax: 334-702-1944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC01175
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: