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General NPI Number Information
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NPI Number | 1407656127
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Entity Type | Organization
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Legal Business Name | BROOKE COUNSELING SERVICES CORP
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 630 SEGOVIA RD OFC
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-6456
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Country | US
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Telephone | 904-806-1812
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 806
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City | ST AUGUSTINE
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State | FL
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Zip | 32085-0806
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Country | US
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Telephone | 904-806-1812
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JACQUELINE DOUGHERTY
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Credential | MS LMHC OS
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Telephone | 904-806-1812
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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 |
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License Number State |
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