Provider Demographics
NPI:1366872996
Name:BROOKS, ASHLEY NICHOLE (MED)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:NICHOLE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 RIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2915
Mailing Address - Country:US
Mailing Address - Phone:662-588-5848
Mailing Address - Fax:
Practice Address - Street 1:521 EVANS RD # 521
Practice Address - Street 2:
Practice Address - City:BOYLE
Practice Address - State:MS
Practice Address - Zip Code:38730-9693
Practice Address - Country:US
Practice Address - Phone:662-588-5848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2401010101YP2500X
MS1826101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional