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NPI Code Detail

MEDICARE: BROOKE HAVIS

MEDICARE: BROOKE HAVIS
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1952251274
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE HAVIS
Provider Business Mailing Address
First Line : 6217 IRENE PORTER ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89031-6301
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9275 W RUSSELL RD STE 205
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-1476
Country : US
Telephone Number : 702-259-4966
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2026
Last Update Date : 01/28/2026

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Directions to “ BROOKE HAVIS ” Practice Location

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