Provider Demographics
NPI:1194142687
Name:UDY, BROOKE MICHELLE (SOCIAL WORKER)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:MICHELLE
Last Name:UDY
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 VETERANS MEMORIAL DR # 122
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-7451
Mailing Address - Country:US
Mailing Address - Phone:254-421-8168
Mailing Address - Fax:254-953-7173
Practice Address - Street 1:1901 VETERANS MEMORIAL DR # 122
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7451
Practice Address - Country:US
Practice Address - Phone:254-421-8168
Practice Address - Fax:254-953-7173
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51963104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX51963OtherTEXAS STATE BOARD OF SOCIAL WORK EXAMINERS