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General NPI Number Information
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NPI Number | 1932539194
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Entity Type | Organization
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Legal Business Name | BROOKS PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 11/25/2013
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Last Update Date | 11/25/2013
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Provider Practice Location Address
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Address Line | 133 OSAGE CT
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City | WALESKA
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State | GA
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Zip | 30183-4007
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Country | US
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Telephone | 954-249-9978
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Fax |
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Provider Business Mailing Address
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Address Line | 133 OSAGE CT
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City | WALESKA
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State | GA
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Zip | 30183-4007
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Country | US
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Telephone | 954-249-9978
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER MICHAEL BROOKS
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Credential | PSYD
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Telephone | 954-249-9978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | TS-T000938
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License Number State | GA
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