Healthcare Provider Details

I. General information

NPI: 1457781346
Provider Name (Legal Business Name): HEATHER BROOKE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2013
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: 970-430-6552
  • Fax:
Mailing address:
  • Phone: 719-480-1525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0012680
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: