Provider Demographics
NPI:1154871796
Name:BROOKS, LISA M (CDP, MSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:BROOKS
Suffix:
Gender:F
Credentials:CDP, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 S COWLEY ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1377
Mailing Address - Country:US
Mailing Address - Phone:509-624-3227
Mailing Address - Fax:509-835-4272
Practice Address - Street 1:628 S COWLEY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1377
Practice Address - Country:US
Practice Address - Phone:509-624-3227
Practice Address - Fax:509-835-4272
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60081434101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)