Healthcare Provider Details

I. General information

NPI: 1003749821
Provider Name (Legal Business Name): BROOKE EDWARDS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 W UNIVERSITY AVE STE 202
FLAGSTAFF AZ
86001-2996
US

IV. Provider business mailing address

628 S FOUNTAINE ST
FLAGSTAFF AZ
86001-5823
US

V. Phone/Fax

Practice location:
  • Phone: 928-863-1798
  • Fax:
Mailing address:
  • Phone: 928-863-1798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number006107
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: