Healthcare Provider Details

I. General information

NPI: 1700627700
Provider Name (Legal Business Name): BROOKE MOYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE RUTH

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E PARK ST
ELIZABETHTOWN PA
17022-2267
US

IV. Provider business mailing address

420 E PARK ST
ELIZABETHTOWN PA
17022-2267
US

V. Phone/Fax

Practice location:
  • Phone: 717-282-2908
  • Fax: 717-459-7558
Mailing address:
  • Phone: 717-282-2908
  • Fax: 717-459-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: