Provider Demographics
NPI:1982277422
Name:BROOKS, LAKEESHA (QMHSIII)
Entity type:Individual
Prefix:
First Name:LAKEESHA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:QMHSIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 STELLA CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1011
Mailing Address - Country:US
Mailing Address - Phone:614-252-8402
Mailing Address - Fax:614-252-7987
Practice Address - Street 1:1289 E LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2838
Practice Address - Country:US
Practice Address - Phone:614-252-8402
Practice Address - Fax:614-252-7987
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician