Provider Demographics
NPI:1427696780
Name:BROOKS, GEORGE JR
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:BROOKS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 MUNGER AVE APT 231
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-4195
Mailing Address - Country:US
Mailing Address - Phone:214-810-6518
Mailing Address - Fax:
Practice Address - Street 1:3535 MUNGER AVE APT 231
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-4195
Practice Address - Country:US
Practice Address - Phone:214-810-6518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9434Medicaid