Provider Demographics
NPI:1699735787
Name:BROOKE, SANDRA (LMHC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BROOKE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11929 IBIS WAY
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8748
Mailing Address - Country:US
Mailing Address - Phone:801-542-7060
Mailing Address - Fax:801-542-7061
Practice Address - Street 1:1312 N MONROE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2623
Practice Address - Country:US
Practice Address - Phone:509-808-4642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4934999-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health