Provider Demographics
NPI:1447955901
Name:MINNICK, BROOKE LEIGH (MS ED, NCC, LPC)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LEIGH
Last Name:MINNICK
Suffix:
Gender:F
Credentials:MS ED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 WALBERT AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-1363
Mailing Address - Country:US
Mailing Address - Phone:484-268-2702
Mailing Address - Fax:
Practice Address - Street 1:2233 WALBERT AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-1363
Practice Address - Country:US
Practice Address - Phone:717-896-0610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015516101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional