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General NPI Number Information
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NPI Number | 1679182984
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Entity Type | Organization
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Legal Business Name | BROOKE OSTERHOUDT, LLC
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 4341 CHARLOTTE HWY STE 202
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City | LAKE WYLIE
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State | SC
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Zip | 29710-7062
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Country | US
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Telephone | 303-408-4455
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Fax |
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Provider Business Mailing Address
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Address Line | 16 HAMILTONS FERRY RD
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City | CLOVER
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State | SC
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Zip | 29710-8911
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Country | US
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Telephone | 303-408-4455
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | SHANA LOTT
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Credential |
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Telephone | 303-408-4455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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