Healthcare Provider Details

I. General information

NPI: 1225292170
Provider Name (Legal Business Name): AUDREY L BROOKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUDREY L BUTTS

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W 27TH ST RM 5S
NEW YORK NY
10001-6208
US

IV. Provider business mailing address

231 S BEMISTON AVE STE 800
SAINT LOUIS MO
63105-1925
US

V. Phone/Fax

Practice location:
  • Phone: 833-351-8255
  • Fax: 888-815-3583
Mailing address:
  • Phone: 833-351-8255
  • Fax: 888-815-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2016013807
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: