Healthcare Provider Details

I. General information

NPI: 1225849276
Provider Name (Legal Business Name): BROOKS COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 EASTERN AVE NE
GRAND RAPIDS MI
49505-4211
US

IV. Provider business mailing address

2040 EASTERN AVE NE
GRAND RAPIDS MI
49505-4211
US

V. Phone/Fax

Practice location:
  • Phone: 925-989-7631
  • Fax:
Mailing address:
  • Phone: 925-989-7631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARLY C BROOKS-HARMON
Title or Position: OWNER/COUNSELOR
Credential: LPC
Phone: 925-989-7631