1972897643 NPI number — MS. ALLENE MAXWELL BROOKS LPC, LISAC

Table of content: MS. ALLENE MAXWELL BROOKS LPC, LISAC (NPI 1972897643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972897643 NPI number — MS. ALLENE MAXWELL BROOKS LPC, LISAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROOKS
Provider First Name:
ALLENE
Provider Middle Name:
MAXWELL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, LISAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROOKS
Provider Other First Name:
GRACE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC, LISAC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1972897643
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4541 W CONTINENTAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85308-3443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-226-6429
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15270 W BROOKSIDE LN
Provider Second Line Business Practice Location Address:
121
Provider Business Practice Location Address City Name:
SURPRISE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85374-2450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-226-6429
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2011

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: 101YA0400X , with the licence number:  1582 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 12652 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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