Doctor Name: | BROOKE L HARRISON |
NPI Number: | 1033510078 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | 12824 |
Business Practice Address: | 203 Cloverdale Blvd Fort Walton Beach, FL - 325471405 |
Business Phone Number: | 8507123779 |
Business Fax Number: | |
Mailing Address: | Po Box 800, SHALIMAR |
State: | FL |
Postal Code: | 325790800 |
Phone Number: | 8507123779 |
Fax Number: | |
NPI Enumeration Date: | 09/09/2014 |
NPI Last Update Date: | 09/09/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 12824 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |