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General NPI Number Information
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NPI Number | 1306963996
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Entity Type | Individual
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Provider Name | BRENDA M BROOKS
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1200 N WEST AVE
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City | JACKSON
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State | MI
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Zip | 49202-2179
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Country | US
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Telephone | 517-780-3391
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Fax | 517-782-6576
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Provider Business Mailing Address
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Address Line | 332 W MONROE ST
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City | JACKSON
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State | MI
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Zip | 49202-2273
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Country | US
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Telephone | 517-780-3391
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Fax | 517-782-6576
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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 | 4703083436
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License Number State | MI
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