MEDICARE: BROOKLYNN MARIE WAY TLMHC

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	136575	IA

General Provider Information

NPI Number	:	1942139613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKLYNN MARIE WAY TLMHC

Provider Business Mailing Address
First Line	:	5517 NE LAVENDER LN
Second Line	:
City	:	ANKENY
State	:	IA
Zip	:	50021-6243
Country	:	US
Telephone Number	:	515-612-2393
Fax Number	:

Provider Business Practice Location Address
First Line	:	1370 NW 114TH ST
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-7030
Country	:	US
Telephone Number	:	515-949-6918
Fax Number	:

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

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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Directions to “ BROOKLYNN MARIE WAY TLMHC” Practice Location

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