Healthcare Provider Details

I. General information

NPI: 1386485761
Provider Name (Legal Business Name): HEATHER BROOKE, LPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 EXPRESS DR
JACKSON TN
38305-6059
US

IV. Provider business mailing address

20 WHISPER CREEK DR
JACKSON TN
38305-6106
US

V. Phone/Fax

Practice location:
  • Phone: 719-480-1525
  • Fax:
Mailing address:
  • Phone: 719-480-1525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. HEATHER DIANE BROOKE
Title or Position: OWNER
Credential: LPC
Phone: 719-480-1525