Provider Demographics
NPI:1063927291
Name:BROOKS, KIMBERLY RENEE MCCUTCHEN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:RENEE MCCUTCHEN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:M
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:247 BRENNING RD
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-5558
Mailing Address - Country:US
Mailing Address - Phone:618-203-8008
Mailing Address - Fax:
Practice Address - Street 1:247 BRENNING RD
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-5558
Practice Address - Country:US
Practice Address - Phone:618-203-8008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490199601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical