Provider Demographics
NPI:1295501609
Name:BROOKS, KATHRYN (MA, LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MA, LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 WILLOW CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4920
Mailing Address - Country:US
Mailing Address - Phone:817-939-0877
Mailing Address - Fax:
Practice Address - Street 1:2350 SW GREEN OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-3708
Practice Address - Country:US
Practice Address - Phone:817-704-6991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93516101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor