MEDICARE: BROOKE KRZOS LCMHC

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	11537	NC
2	101YM0800X	Mental Health Counselor	A11537	NC

General Provider Information

NPI Number	:	1982087706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE KRZOS LCMHC

Provider Business Mailing Address
First Line	:	9175 E LAKE RD
Second Line	:
City	:	CALABASH
State	:	NC
Zip	:	28467-2793
Country	:	US
Telephone Number	:	919-323-6957
Fax Number	:

Provider Business Practice Location Address
First Line	:	7224 JANSTON DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-1082
Country	:	US
Telephone Number	:	919-753-1080
Fax Number	:

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

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	02/07/2023

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Directions to “ BROOKE KRZOS LCMHC” Practice Location

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