Healthcare Provider Details

I. General information

NPI: 1811961592
Provider Name (Legal Business Name): MARCIE P BROOKS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 ST FRANCIS DRIVE
SANTA FE NM
87505
US

IV. Provider business mailing address

15 AMIGOS LANE
SANTA FE NM
87508
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-7754
  • Fax:
Mailing address:
  • Phone: 505-989-7754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0692
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: