Basic Information
| Provider Information | |||||||||
| NPI: | 1366876641 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAMARTINA | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | THERESE' | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 309 SHADY LN | ||||||||
| Address2: | |||||||||
| City: | GATESVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765282543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3614429674 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 207 N LUTTERLOH AVE | ||||||||
| Address2: | |||||||||
| City: | GATESVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765281423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2548655844 | ||||||||
| FaxNumber: | 2548651420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2013 | ||||||||
| LastUpdateDate: | 08/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 64861 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.