Provider Demographics
NPI:1962900563
Name:BROOKS BEHAVIORAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:BROOKS BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCADC
Authorized Official - Phone:301-732-5857
Mailing Address - Street 1:20 W 3RD ST # 1-B
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6077
Mailing Address - Country:US
Mailing Address - Phone:301-732-5857
Mailing Address - Fax:
Practice Address - Street 1:20 W 3RD ST # 1-B
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6077
Practice Address - Country:US
Practice Address - Phone:301-732-5857
Practice Address - Fax:301-732-5857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD258826900Medicaid