Provider Demographics
NPI:1972970531
Name:BROOKE MARTIN LPC PLLC
Entity type:Organization
Organization Name:BROOKE MARTIN LPC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-571-6648
Mailing Address - Street 1:3201 UNIVERSITY DR E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3475
Mailing Address - Country:US
Mailing Address - Phone:979-229-4203
Mailing Address - Fax:844-388-6134
Practice Address - Street 1:3201 UNIVERSITY DR E
Practice Address - Street 2:SUITE 200
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3475
Practice Address - Country:US
Practice Address - Phone:979-229-4203
Practice Address - Fax:844-388-6134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-29
Last Update Date:2015-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67067251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1598106221Medicaid