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General NPI Number Information
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NPI Number | 1033510078
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Entity Type | Individual
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Provider Name | BROOKE L HARRISON LMHC
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Gender | Female
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 09/09/2014
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Provider Practice Location Address
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Address Line | 203 CLOVERDALE BLVD
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-1405
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Country | US
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Telephone | 850-712-3779
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 800
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City | SHALIMAR
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State | FL
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Zip | 32579-0800
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Country | US
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Telephone | 850-712-3779
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 12824
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License Number State | FL
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