Provider Demographics
NPI:1316156730
Name:BROOKS, TIM LOUIS (LPC)
Entity type:Individual
Prefix:MR
First Name:TIM
Middle Name:LOUIS
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 LAKE LOGAN RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:TN
Mailing Address - Zip Code:38449-5236
Mailing Address - Country:US
Mailing Address - Phone:931-309-7857
Mailing Address - Fax:931-423-0019
Practice Address - Street 1:104 IVY LN
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4550
Practice Address - Country:US
Practice Address - Phone:931-309-7857
Practice Address - Fax:931-423-0019
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1563101YP2500X
AL1349101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1349OtherLPC
TN1563OtherLPC