Provider Demographics
NPI:1174134506
Name:BROOKS, RENAE LANE (LPC)
Entity type:Individual
Prefix:
First Name:RENAE
Middle Name:LANE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 MURRAY ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-2069
Mailing Address - Country:US
Mailing Address - Phone:734-384-0852
Mailing Address - Fax:
Practice Address - Street 1:23 W 1ST ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-2332
Practice Address - Country:US
Practice Address - Phone:734-639-2262
Practice Address - Fax:734-621-5075
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018520101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional