1104101393 NPI number — MS. JUNE ELIZABETH BROOKSHIRE M.S., LPC

Table of content: MS. JUNE ELIZABETH BROOKSHIRE M.S., LPC (NPI 1104101393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104101393 NPI number — MS. JUNE ELIZABETH BROOKSHIRE M.S., LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROOKSHIRE
Provider First Name:
JUNE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WINTER
Provider Other First Name:
JUNE
Provider Other Middle Name:
JOHNSON
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
B.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104101393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1901 CENTRAL DR
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76021-5869
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-726-3034
Provider Business Mailing Address Fax Number:
817-283-0820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 CENTRAL DR
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76021-5869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-726-3034
Provider Business Practice Location Address Fax Number:
817-283-0820
Provider Enumeration Date:
10/19/2011

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: 101YP2500X , with the licence number:  63397 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com