Provider Demographics
NPI:1275063364
Name:BROOKS, JANE
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:
Other - Last Name:MCCONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7520 MONTGOMERY BLVD NE BLDG E15
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1586
Mailing Address - Country:US
Mailing Address - Phone:505-226-6380
Mailing Address - Fax:505-214-5852
Practice Address - Street 1:7510 MONTGOMERY BLVD NE STE 202
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1500
Practice Address - Country:US
Practice Address - Phone:505-226-6355
Practice Address - Fax:505-214-5852
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health