Healthcare Provider Details

I. General information

NPI: 1619420288
Provider Name (Legal Business Name): BRITTNI BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 08/16/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5-4280 KUHIO HWY STE GC
PRINCEVILLE HI
96722-5451
US

IV. Provider business mailing address

PO BOX 223035
PRINCEVILLE HI
96722-3035
US

V. Phone/Fax

Practice location:
  • Phone: 808-639-9236
  • Fax:
Mailing address:
  • Phone: 808-847-3285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number593
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: