Provider Demographics
NPI:1972897643
Name:BROOKS, ALLENE MAXWELL (LPC, LISAC)
Entity type:Individual
Prefix:MS
First Name:ALLENE
Middle Name:MAXWELL
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LPC, LISAC
Other - Prefix:MS
Other - First Name:GRACE
Other - Middle Name:M
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, LISAC
Mailing Address - Street 1:4541 W CONTINENTAL DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3443
Mailing Address - Country:US
Mailing Address - Phone:480-226-6429
Mailing Address - Fax:
Practice Address - Street 1:15270 W BROOKSIDE LN
Practice Address - Street 2:121
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2450
Practice Address - Country:US
Practice Address - Phone:480-226-6429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1582101YA0400X
AZ12652101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)