Healthcare Provider Details

I. General information

NPI: 1245516970
Provider Name (Legal Business Name): LEATRICE RENEE BROOKS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 WHITES RD STE 4
KALAMAZOO MI
49008-2883
US

IV. Provider business mailing address

5016 COOPERS LANDING DR APT 3D
KALAMAZOO MI
49004-7650
US

V. Phone/Fax

Practice location:
  • Phone: 866-232-5389
  • Fax:
Mailing address:
  • Phone: 866-232-5389
  • Fax: 866-938-3746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301015072
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301015072
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: