Provider Demographics
NPI:1528170701
Name:BROOKS, CAROLE ANNE (MA)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:ANNE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CAROLE
Other - Middle Name:ANNE
Other - Last Name:KLOSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2103 S WADSWORTH BLVD
Mailing Address - Street 2:SUITE # 250
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-2641
Mailing Address - Country:US
Mailing Address - Phone:303-550-4592
Mailing Address - Fax:
Practice Address - Street 1:2103 S WADSWORTH BLVD
Practice Address - Street 2:SUITE # 250
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-2641
Practice Address - Country:US
Practice Address - Phone:303-550-4592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9039101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health