MEDICARE: MELISSA FAY BROOKS ALC

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	04600	AL

General Provider Information

NPI Number	:	1194505800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA FAY BROOKS ALC

Provider Business Mailing Address
First Line	:	300 VESTAVIA PKWY STE 1500
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35216-3753
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 VESTAVIA PKWY STE 1500
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35216-3753
Country	:	US
Telephone Number	:	205-881-2705
Fax Number	:

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

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	10/02/2023

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