MEDICARE: MICHAEL T BROOKS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1134851710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL T BROOKS LLC

Provider Business Mailing Address
First Line	:	6937 W PALMER LAKE DR
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-4201
Country	:	US
Telephone Number	:	612-272-5718
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 EMERSON AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-2512
Country	:	US
Telephone Number	:	612-272-5718
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL BROOKS
Credential	:
Telephone Number	:	612-272-5718

Provider Enumeration Date	:	06/30/2022
Last Update Date	:	06/30/2022

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