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General NPI Number Information
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NPI Number | 1972970531
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Entity Type | Organization
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Legal Business Name | BROOKE MARTIN LPC PLLC
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Dates
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Enumeration Date | 08/29/2015
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Last Update Date | 08/29/2015
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Provider Practice Location Address
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Address Line | 3201 UNIVERSITY DR E SUITE 200
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City | BRYAN
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State | TX
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Zip | 77802-3475
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Country | US
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Telephone | 979-229-4203
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Fax | 844-388-6134
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Provider Business Mailing Address
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Address Line | 3201 UNIVERSITY DR E SUITE 200
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City | BRYAN
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State | TX
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Zip | 77802-3475
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Country | US
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Telephone | 979-229-4203
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Fax | 844-388-6134
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | BROOKE MARTIN
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Credential |
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Telephone | 979-571-6648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 67067
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License Number State | TX
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