MEDICARE: MS. SUSAN C BROOKS MS, LMFT

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	NC 510	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	131WE	OTHER	NC	BLUE CROSS BLUE SHIELD
2	131WE	OTHER	NC	STATE EMPLOYEES & TEACHER

General Provider Information

NPI Number	:	1700870490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN C BROOKS MS, LMFT

Provider Business Mailing Address
First Line	:	112 N CIRCLE DR
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-2430
Country	:	US
Telephone Number	:	252-443-5870
Fax Number	:	252-443-9101

Provider Business Practice Location Address
First Line	:	112 N CIRCLE DR
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-2430
Country	:	US
Telephone Number	:	252-443-5870
Fax Number	:	252-443-9101

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	07/08/2007

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