Healthcare Provider Details

I. General information

NPI: 1821654914
Provider Name (Legal Business Name): BROOKE JUNE ASHLEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 GILBERT ST
FLINT MI
48532-3527
US

IV. Provider business mailing address

740 CENTER ST
CLIO MI
48420-1148
US

V. Phone/Fax

Practice location:
  • Phone: 810-422-9406
  • Fax:
Mailing address:
  • Phone: 810-686-7313
  • Fax: 810-686-7315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801099466
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801099466
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: