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General NPI Number Information
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NPI Number | 1679838635
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Entity Type | Individual
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Provider Name | TYNESHIA A BROOKS M.S. CPCI
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Gender | Female
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 913 CRESCENT FALLS ST
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City | HENDERSON
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State | NV
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Zip | 89011-2516
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Country | US
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Telephone | 702-498-1743
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 92168
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City | HENDERSON
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State | NV
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Zip | 89009-2168
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Country | US
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Telephone | 702-498-1743
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Fax |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | CP0280
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License Number State | NV
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CP0280
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License Number State | NV
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Taxonomy #6
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CP0280
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License Number State | NV
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