Healthcare Provider Details

I. General information

NPI: 1316156730
Provider Name (Legal Business Name): TIM LOUIS BROOKS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 IVY LN
PULASKI TN
38478-4550
US

IV. Provider business mailing address

1027 LAKE LOGAN RD
ARDMORE TN
38449-5236
US

V. Phone/Fax

Practice location:
  • Phone: 931-309-7857
  • Fax: 931-423-0019
Mailing address:
  • Phone: 931-309-7857
  • Fax: 931-423-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1563
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1349
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1349
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerLPC
# 2
Identifier1563
Identifier TypeOTHER
Identifier StateTN
Identifier IssuerLPC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: