Healthcare Provider Details

I. General information

NPI: 1396165767
Provider Name (Legal Business Name): BROOKS WITTER MA, LPC, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 5TH ST STE 205
AMES IA
50010-6259
US

IV. Provider business mailing address

30628 DEER DR
HUXLEY IA
50124-8067
US

V. Phone/Fax

Practice location:
  • Phone: 515-337-0335
  • Fax:
Mailing address:
  • Phone: 515-337-0335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5130
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: