Basic Information
| Provider Information | |||||||||
| NPI: | 1700860798 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROOKS | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW, LCAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8320 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462276066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178825122 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8320 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462276066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178825122 | ||||||||
| FaxNumber: | 3178888642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 04/03/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 34001902A | IN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YA0400X | 87000645A | IN | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.