1326209669 NPI number — HOPE MARIE BROOKENS MA, LPC, CAADC

Table of content: HOPE MARIE BROOKENS MA, LPC, CAADC (NPI 1326209669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326209669 NPI number — HOPE MARIE BROOKENS MA, LPC, CAADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROOKENS
Provider First Name:
HOPE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC, CAADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326209669
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3949 SPARKS DR SE STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49546-6110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-957-5850
Provider Business Mailing Address Fax Number:
616-957-5853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1190 E APPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUSKEGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49442-3758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-737-9840
Provider Business Practice Location Address Fax Number:
231-638-9180
Provider Enumeration Date:
06/19/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  6401009569 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)