Healthcare Provider Details

I. General information

NPI: 1912431115
Provider Name (Legal Business Name): BROOKS FAMILY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 W CHEYENNE AVE SUITE 100-A
N LAS VEGAS NV
89032-8212
US

IV. Provider business mailing address

3550 W CHEYENNE AVE SUITE 100-A
N LAS VEGAS NV
89032-8212
US

V. Phone/Fax

Practice location:
  • Phone: 702-570-5200
  • Fax: 702-570-5201
Mailing address:
  • Phone: 702-570-5200
  • Fax: 702-570-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6983
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number9037
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DEVIN BROOKS
Title or Position: CEO
Credential:
Phone: 702-570-5200