Healthcare Provider Details

I. General information

NPI: 1952205221
Provider Name (Legal Business Name): BROOK D MELVIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 E CASS ST
JOLIET IL
60432-2812
US

IV. Provider business mailing address

213 E CASS ST
JOLIET IL
60432-2812
US

V. Phone/Fax

Practice location:
  • Phone: 815-726-3377
  • Fax: 877-716-6494
Mailing address:
  • Phone: 815-726-3377
  • Fax: 877-716-6494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number45706
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: