MEDICARE: KENDRIC BROOKS

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

General Provider Information

NPI Number	:	1932522612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRIC BROOKS

Provider Business Mailing Address
First Line	:	6744 BILTMORE GARDEN ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0226
Country	:	US
Telephone Number	:	702-325-5940
Fax Number	:

Provider Business Practice Location Address
First Line	:	6744 BILTMORE GARDEN ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0226
Country	:	US
Telephone Number	:	702-325-5940
Fax Number	:

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

Provider Enumeration Date	:	01/30/2014
Last Update Date	:	01/30/2014

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Directions to “ KENDRIC BROOKS ” Practice Location

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