Provider Demographics
NPI:1396165767
Name:WITTER, BROOKS (MA, LPC, LMHC)
Entity type:Individual
Prefix:
First Name:BROOKS
Middle Name:
Last Name:WITTER
Suffix:
Gender:M
Credentials:MA, LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30628 DEER DR
Mailing Address - Street 2:
Mailing Address - City:HUXLEY
Mailing Address - State:IA
Mailing Address - Zip Code:50124-8067
Mailing Address - Country:US
Mailing Address - Phone:515-337-0335
Mailing Address - Fax:
Practice Address - Street 1:208 5TH ST STE 205
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6259
Practice Address - Country:US
Practice Address - Phone:515-337-0335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5130101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional