Provider Demographics
NPI:1386311793
Name:EATON, BROOKE LYNN (LMSW)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LYNN
Last Name:EATON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N GOVERNMENT WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2976
Mailing Address - Country:US
Mailing Address - Phone:208-273-9147
Mailing Address - Fax:
Practice Address - Street 1:500 N GOVERNMENT WAY STE 300
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2976
Practice Address - Country:US
Practice Address - Phone:509-838-4615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-43985104100000X
WACG61229293101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty