Provider Demographics
NPI:1124842448
Name:BROOKS FAMILY THERAPY INC.
Entity type:Organization
Organization Name:BROOKS FAMILY THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-474-8942
Mailing Address - Street 1:406 MAIN ST STE L
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-3916
Mailing Address - Country:US
Mailing Address - Phone:707-474-8942
Mailing Address - Fax:707-314-3409
Practice Address - Street 1:406 MAIN ST STE L
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-3916
Practice Address - Country:US
Practice Address - Phone:707-474-8942
Practice Address - Fax:707-314-3409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health