Provider Demographics
NPI:1366967887
Name:BROOKS, TERESA W (MA)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:W
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9005 WALKER RD APT 824
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2479
Mailing Address - Country:US
Mailing Address - Phone:318-840-1976
Mailing Address - Fax:
Practice Address - Street 1:9005 WALKER ROAD
Practice Address - Street 2:APT. 824
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2479
Practice Address - Country:US
Practice Address - Phone:318-840-1976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty