1508821380 NPI number — MRS. KATHRYN BROOKS PH.D, LPC

Table of content: MRS. KATHRYN BROOKS PH.D, LPC (NPI 1508821380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508821380 NPI number — MRS. KATHRYN BROOKS PH.D, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROOKS
Provider First Name:
KATHRYN
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PH.D, LPC
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:
1508821380
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 W KING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHIPPENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17257-1212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-658-5626
Provider Business Mailing Address Fax Number:
717-532-9308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 W KING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHIPPENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17257-1212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-658-5626
Provider Business Practice Location Address Fax Number:
717-532-9308
Provider Enumeration Date:
04/17/2006

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: 101YM0800X , with the licence number:  PC000376 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 536056 . This is a "VALUE OPTIONS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50042765 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 810554001 . This is a "TEAM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 239717 . This is a "COMPSYCH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 341996 . This is a "MHNET-TRICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001959469 . This is a "COMMUNITY BEHAVIORAL HEAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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