Healthcare Provider Details

I. General information

NPI: 1770728321
Provider Name (Legal Business Name): TAMI BROOKS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11631 VICTORY BLVD
NORTH HOLLYWOOD CA
91606-3572
US

IV. Provider business mailing address

4019 WESTERLY PL STE 102
NEWPORT BEACH CA
92660-2333
US

V. Phone/Fax

Practice location:
  • Phone: 818-980-3855
  • Fax: 818-509-3049
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number94026793
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: