Healthcare Provider Details

I. General information

NPI: 1215353180
Provider Name (Legal Business Name): JILL BROOKS M.S., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 S 8TH ST #3300
NOBLESVILLE IN
46060-2605
US

IV. Provider business mailing address

23 S 8TH ST #3300
NOBLESVILLE IN
46060-2605
US

V. Phone/Fax

Practice location:
  • Phone: 317-507-9592
  • Fax:
Mailing address:
  • Phone: 317-507-9592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35001482A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: