MEDICARE: ERICA RENEE BROOKS PLPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2008034730	MO

General Provider Information

NPI Number	:	1023259041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA RENEE BROOKS PLPC

Provider Business Mailing Address
First Line	:	4047 WATERFALL DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63034-2023
Country	:	US
Telephone Number	:	314-956-0869
Fax Number	:

Provider Business Practice Location Address
First Line	:	7750 CLAYTON RD STE 103
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-1343
Country	:	US
Telephone Number	:	314-647-7708
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2009
Last Update Date	:	03/20/2009

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