Basic Information
| Provider Information | |||||||||
| NPI: | 1912419607 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROOKSHIRE | ||||||||
| FirstName: | CAROLE | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | MFT 115869 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10341 CANOGA AVE UNIT 43 | ||||||||
| Address2: | |||||||||
| City: | CHATSWORTH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913112216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8186138417 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 660 E LOS ANGELES AVE | ||||||||
| Address2: | |||||||||
| City: | SIMI VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930651873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182060360 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2017 | ||||||||
| LastUpdateDate: | 01/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 115869 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YA0400X | 9298 | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 118569 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.