MEDICARE: MR. TIM LOUIS BROOKS LPC

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	101YP2500X	Professional Counselor	1563	TN
2	101YP2500X	Professional Counselor	1349	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1349	OTHER	AL	LPC
2	1563	OTHER	TN	LPC

General Provider Information

NPI Number	:	1316156730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIM LOUIS BROOKS LPC

Provider Business Mailing Address
First Line	:	1027 LAKE LOGAN RD
Second Line	:
City	:	ARDMORE
State	:	TN
Zip	:	38449-5236
Country	:	US
Telephone Number	:	931-309-7857
Fax Number	:	931-423-0019

Provider Business Practice Location Address
First Line	:	104 IVY LN
Second Line	:
City	:	PULASKI
State	:	TN
Zip	:	38478-4550
Country	:	US
Telephone Number	:	931-309-7857
Fax Number	:	931-423-0019

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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