MEDICARE: MRS. BROOKE ELIZABETH LANDS

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	101Y00000X	Counselor	6651G	AL
2	101Y00000X	Counselor	0009926330	CO

General Provider Information

NPI Number	:	1902563752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BROOKE ELIZABETH LANDS

Provider Business Mailing Address
First Line	:	6407 JARMON RD UNIT 100
Second Line	:
City	:	GUNTERSVILLE
State	:	AL
Zip	:	35976-9342
Country	:	US
Telephone Number	:	256-673-8277
Fax Number	:

Provider Business Practice Location Address
First Line	:	3595 E FOUNTAIN BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-1733
Country	:	US
Telephone Number	:	719-623-7190
Fax Number	:

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

Provider Enumeration Date	:	11/29/2021
Last Update Date	:	05/27/2025

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