MEDICARE: MRS. NICOLE BROOKS LAC

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	23879	AZ

General Provider Information

NPI Number	:	1669328704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE BROOKS LAC

Provider Business Mailing Address
First Line	:	14905 E CIRCLE W RANCH PL
Second Line	:
City	:	VAIL
State	:	AZ
Zip	:	85641-8952
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10379 E CAPERCAILLIE ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-8971
Country	:	US
Telephone Number	:	520-780-2569
Fax Number	:

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

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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