Healthcare Provider Details

I. General information

NPI: 1558500223
Provider Name (Legal Business Name): DAVID M BROOKS PHD PSYCHOLOGICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 N LAKE SHORE DR # 5E
CHICAGO IL
60613-3301
US

IV. Provider business mailing address

3800 N LAKE SHORE DR # 5E
CHICAGO IL
60613-3301
US

V. Phone/Fax

Practice location:
  • Phone: 310-498-0555
  • Fax:
Mailing address:
  • Phone: 310-498-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 20877
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberPSY 20877
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID MICHAEL BROOKS
Title or Position: OWNER AND PRESIDENT
Credential: PH.D.
Phone: 310-498-0555