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1174303119 NPI number — REBECCA ANN BROOKS MA, LPCC

NPI Number: 1174303119
Health Care Provider/Practitioner: REBECCA ANN BROOKS MA, LPCC

Information about “1174303119” NPI (REBECCA ANN BROOKS MA, LPCC) exists in 1174303119 in HTML format HTML  |  1174303119 in plain Text format TXT  |  1174303119 in PDF (Portable Document Format) PDF  |  1174303119 in an XML format XML  formats.

NPI Number : 1174303119 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174303119",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BROOKS",
    "FirstName": "REBECCA",
    "MiddleName": "ANN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MA, LPCC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GONSIOR",
    "OtherFirstName": "REBECCA",
    "OtherMiddleName": "ANN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MA, LPCC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "8170 33RD AVE S # MS 21110Q",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BLOOMINGTON",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55425-4516",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3525 MONTEREY DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ST LOUIS PARK",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55416-5275",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "952-993-6200",
    "PracticeLocationAddressFaxNumber": "952-993-5631",
    "EnumerationDate": "10/05/2023",
    "LastUpdateDate": "08/06/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "4052",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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