Basic Information
| Provider Information | |||||||||
| NPI: | 1548380462 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROOKE | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | DAWN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BHRS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6202 S LEWIS AVE | ||||||||
| Address2: | STE J, | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741361099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185879471 | ||||||||
| FaxNumber: | 9185601399 | ||||||||
| Practice Location | |||||||||
| Address1: | 6202 S LEWIS AVE | ||||||||
| Address2: | STE J, | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741361099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185844549 | ||||||||
| FaxNumber: | 9183821886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 03/06/2013 | ||||||||
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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 | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.