Provider Demographics
NPI:1124684709
Name:BROOKS, MEAGAN LAVELLE (CSW)
Entity type:Individual
Prefix:MRS
First Name:MEAGAN
Middle Name:LAVELLE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 S 400 W STE 102
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-5359
Mailing Address - Country:US
Mailing Address - Phone:801-251-6884
Mailing Address - Fax:
Practice Address - Street 1:36 S 400 W STE 102
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5359
Practice Address - Country:US
Practice Address - Phone:801-251-6884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11256803-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT11256803-3502OtherDOPL LICENSING NUMBER