Healthcare Provider Details

I. General information

NPI: 1346491727
Provider Name (Legal Business Name): BROOKE M DEY MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 RIVERSIDE DR STE B11
GREEN BAY WI
54301-1957
US

IV. Provider business mailing address

2417 MANITOWOC RD
GREEN BAY WI
54311-5323
US

V. Phone/Fax

Practice location:
  • Phone: 920-544-6818
  • Fax: 920-212-4997
Mailing address:
  • Phone: 920-544-6818
  • Fax: 920-212-4997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5388-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5388-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: