Healthcare Provider Details

I. General information

NPI: 1679046791
Provider Name (Legal Business Name): STEPHANIE LYNN BROOKE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 WESTGATE BLVD
YOUNGSTOWN OH
44515-3403
US

IV. Provider business mailing address

4496 MAHONING AVE. #1038
YOUNGSTOWN OH
44515
US

V. Phone/Fax

Practice location:
  • Phone: 567-868-4001
  • Fax:
Mailing address:
  • Phone: 330-967-0366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2303351
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1801109-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: