Provider Demographics
NPI:1366876641
Name:LAMARTINA, BROOKE THERESE' (LPC)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:THERESE'
Last Name:LAMARTINA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76528-2543
Mailing Address - Country:US
Mailing Address - Phone:361-442-9674
Mailing Address - Fax:
Practice Address - Street 1:207 N LUTTERLOH AVE
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76528-1423
Practice Address - Country:US
Practice Address - Phone:254-865-5844
Practice Address - Fax:254-865-1420
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64861101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional