Provider Demographics
NPI:1447495353
Name:BROOKS, CARL DAVID (LPCC, LPC)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:DAVID
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LPCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 SCOTTSVILLE RD
Mailing Address - Street 2:SUITE 23
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-6310
Mailing Address - Country:US
Mailing Address - Phone:270-393-0074
Mailing Address - Fax:270-393-0067
Practice Address - Street 1:2530 SCOTTSVILLE RD
Practice Address - Street 2:SUITE 23
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-6310
Practice Address - Country:US
Practice Address - Phone:270-393-0074
Practice Address - Fax:270-393-0067
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0198101YP2500X
TN1426101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY29100302OtherKENTUCKY IMPACT PLUS