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NPI Code Detail

MEDICARE: ALFONSO RAFEKY BROOKS JR.

MEDICARE:   ALFONSO RAFEKY BROOKS JR.
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1891305058
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALFONSO RAFEKY BROOKS JR.
Provider Business Mailing Address
First Line : 6332 LEGEND FALLS ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89081-6621
Country : US
Telephone Number : 702-720-7029
Fax Number :
Provider Business Practice Location Address
First Line : 6332 LEGEND FALLS ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89081-6621
Country : US
Telephone Number : 702-720-7029
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2020
Last Update Date : 08/03/2020

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Directions to “ ALFONSO RAFEKY BROOKS JR. ” Practice Location

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