Healthcare Provider Details

I. General information

NPI: 1578401170
Provider Name (Legal Business Name): REBEKAH BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4638 W CUMBERLAND AVE
MIDDLESBORO KY
40965-9076
US

IV. Provider business mailing address

72 BROOKS LOOP
PINEVILLE KY
40977-7885
US

V. Phone/Fax

Practice location:
  • Phone: 606-499-6400
  • Fax:
Mailing address:
  • Phone: 606-499-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number301773
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: