Provider Demographics
NPI:1992083919
Name:BROOKS, MARYSUE (MA, LPC)
Entity type:Individual
Prefix:
First Name:MARYSUE
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5607 LONGSHADOW DR
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-6748
Mailing Address - Country:US
Mailing Address - Phone:832-419-7525
Mailing Address - Fax:
Practice Address - Street 1:16815 ROYAL CREST DR STE 140
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2549
Practice Address - Country:US
Practice Address - Phone:832-419-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65850101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional