Doctor Name: | BROOKE CHAMPT |
NPI Number: | 1003238007 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LLMSW |
License Number: | 6801095707 |
Business Practice Address: | 527 Cobb St Cadillac, MI - 496012540 |
Business Phone Number: | 2318763244 |
Business Fax Number: | |
Mailing Address: | 820 Shady Ln, TRAVERSE CITY |
State: | MI |
Postal Code: | 496864344 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 01/09/2014 |
NPI Last Update Date: | 01/09/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 6801095707 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |