Healthcare Provider Details

I. General information

NPI: 1346848454
Provider Name (Legal Business Name): BROOKE A BILYK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6127 GREEN BAY RD STE 200
KENOSHA WI
53142-2929
US

IV. Provider business mailing address

6127 GREEN BAY RD STE 200
KENOSHA WI
53142-2929
US

V. Phone/Fax

Practice location:
  • Phone: 262-654-8366
  • Fax:
Mailing address:
  • Phone: 262-654-8366
  • Fax: 262-842-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4771-226
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10054-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: