Provider Demographics
NPI:1487868931
Name:BRUNKEN, BROOKE LEIGH (LPC)
Entity type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:LEIGH
Last Name:BRUNKEN
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 1:419 COLBY LANCE ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-8304
Mailing Address - Country:US
Mailing Address - Phone:405-408-2246
Mailing Address - Fax:
Practice Address - Street 1:419 COLBY LANCE ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-8304
Practice Address - Country:US
Practice Address - Phone:405-408-2246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4721101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health