Healthcare Provider Details

I. General information

NPI: 1669098844
Provider Name (Legal Business Name): JAMES EARL BROOKS I M.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 CLARK ST
SOUTH BELOIT IL
61080-1317
US

IV. Provider business mailing address

2240 PRAIRIE AVE
BELOIT WI
53511-2648
US

V. Phone/Fax

Practice location:
  • Phone: 779-770-9713
  • Fax:
Mailing address:
  • Phone: 608-361-7200
  • Fax: 608-361-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: