Provider Demographics
NPI:1154992873
Name:BROOKS, JESSICA RAE (LMHC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 SW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-8215
Mailing Address - Country:US
Mailing Address - Phone:239-404-5222
Mailing Address - Fax:
Practice Address - Street 1:3321 DEL PRADO BLVD S STE 12
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7263
Practice Address - Country:US
Practice Address - Phone:941-876-8033
Practice Address - Fax:239-439-7822
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-03
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22385101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113878700Medicaid