Healthcare Provider Details

I. General information

NPI: 1104687037
Provider Name (Legal Business Name): CHRISTINA MARIE BROOKS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N WELO ST
TIOGA ND
58852-7157
US

IV. Provider business mailing address

810 N WELO ST
TIOGA ND
58852-7157
US

V. Phone/Fax

Practice location:
  • Phone: 701-664-3305
  • Fax:
Mailing address:
  • Phone: 701-664-3305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1334-11-1-23-573
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: