Provider Demographics
NPI:1083585459
Name:HARRALSON, BROOKE (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:HARRALSON
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 BRANDYWINE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-8198
Mailing Address - Country:US
Mailing Address - Phone:817-889-4454
Mailing Address - Fax:
Practice Address - Street 1:8821 DAVIS BLVD STE 210
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-0328
Practice Address - Country:US
Practice Address - Phone:817-381-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99297101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional