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General NPI Number Information
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NPI Number | 1154672574
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Entity Type | Individual
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Provider Name | GARY ROGER BROOKS PHD
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Gender | Male
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Dates
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Enumeration Date | 09/25/2012
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 2027 S 61ST ST SUITE 122
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City | TEMPLE
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State | TX
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Zip | 76504-6867
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Country | US
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Telephone | 254-778-6922
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Fax | 254-778-4332
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Provider Business Mailing Address
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Address Line | 2027 S 61ST ST SUITE 122
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City | TEMPLE
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State | TX
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Zip | 76504-6867
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Country | US
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Telephone | 254-778-6922
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Fax | 254-778-4332
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0-1381
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License Number State | TX
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