Healthcare Provider Details

I. General information

NPI: 1508821380
Provider Name (Legal Business Name): KATHRYN BROOKS PH.D, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W KING ST
SHIPPENSBURG PA
17257-1212
US

IV. Provider business mailing address

20 W KING ST
SHIPPENSBURG PA
17257-1212
US

V. Phone/Fax

Practice location:
  • Phone: 717-658-5626
  • Fax: 717-532-9308
Mailing address:
  • Phone: 717-658-5626
  • Fax: 717-532-9308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC000376
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: