Provider Demographics
NPI:1972801215
Name:GAGE, BROOKE ELIZABETH (LPC)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ELIZABETH
Last Name:GAGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ELIZABETH
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6112 DEVINNEY WAY
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127
Mailing Address - Country:US
Mailing Address - Phone:918-284-9333
Mailing Address - Fax:918-342-2641
Practice Address - Street 1:8937 S GARNETT RD
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-6004
Practice Address - Country:US
Practice Address - Phone:918-872-9777
Practice Address - Fax:918-872-9779
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2024-08-20
Deactivation Date:2013-05-06
Deactivation Code:
Reactivation Date:2024-08-20
Provider Licenses
StateLicense IDTaxonomies
OK1486101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1486OtherLICENSE #1486