Healthcare Provider Details

I. General information

NPI: 1861273716
Provider Name (Legal Business Name): SYDNEY C BROOKS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 W UNIVERSITY DR
PROSPER TX
75078-9805
US

IV. Provider business mailing address

PO BOX 99213
FORT WORTH TX
76199-0213
US

V. Phone/Fax

Practice location:
  • Phone: 682-303-4200
  • Fax: 682-303-4242
Mailing address:
  • Phone: 682-885-1860
  • Fax: 682-885-1396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number87152
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: