Provider Demographics
NPI:1922500024
Name:RAWLS, BROOKE ALIDA
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALIDA
Last Name:RAWLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 5TH ST APT 304
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-1341
Mailing Address - Country:US
Mailing Address - Phone:323-432-0066
Mailing Address - Fax:
Practice Address - Street 1:833 5TH ST APT 304
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-1341
Practice Address - Country:US
Practice Address - Phone:323-432-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF102739106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist