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NPI Code Detail

MEDICARE: BROOKLYNN E MAXON-PACHECO LBSW, LAC

MEDICARE: BROOKLYNN E MAXON-PACHECO LBSW, 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
1101YA0400XAddiction (Substance Use Disorder) Counselor2009ND

General Provider Information

NPI Number : 1770385817
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKLYNN E MAXON-PACHECO LBSW, LAC
Provider Business Mailing Address
First Line : 1308 ELBOWOOD LN
Second Line :
City : BISMARCK
State : ND
Zip : 58503-5712
Country : US
Telephone Number : 701-751-8260
Fax Number : 701-751-0710
Provider Business Practice Location Address
First Line : 1308 ELBOWOOD LN
Second Line :
City : BISMARCK
State : ND
Zip : 58503-5712
Country : US
Telephone Number : 701-751-8260
Fax Number : 701-751-2274
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2025
Last Update Date : 01/20/2026

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