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NPI Code Detail

MEDICARE: MRS. MYCHELE DANAE BROOKS LCSW, ACADC

MEDICARE: MRS. MYCHELE DANAE BROOKS LCSW, ACADC
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
11041C0700XClinical Social WorkerLCSW 967ID

General Provider Information

NPI Number : 1063699809
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MYCHELE DANAE BROOKS LCSW, ACADC
Provider Business Mailing Address
First Line : 500 W FORT ST
Second Line :
City : BOISE
State : ID
Zip : 83702-4599
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 500 W FORT ST
Second Line :
City : BOISE
State : ID
Zip : 83702-4501
Country : US
Telephone Number : 208-426-8806
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2008
Last Update Date : 03/12/2026

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