=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578401170
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBEKAH BROOKS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2026
-----------------------------------------------------
Last Update Date | 03/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4638 W CUMBERLAND AVE
-----------------------------------------------------
City | MIDDLESBORO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40965-9076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-499-6400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 72 BROOKS LOOP
-----------------------------------------------------
City | PINEVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40977-7885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-499-6400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 301773
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------