| Doctor Name: | JESSICA BROCKMEIER |
| NPI Number: | 1245624998 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PLPC |
| License Number: | 2015006040 |
| Business Practice Address: | 411 3rd Street Monett, MO - 657089999 |
| Business Phone Number: | 4174761000 |
| Business Fax Number: | 4174761082 |
| Mailing Address: | 3246 E Old Stone Rd, Apt D105 BROOKLINE |
| State: | MO |
| Postal Code: | 656199620 |
| Phone Number: | 4174761000 |
| Fax Number: | 4174761082 |
| NPI Enumeration Date: | 03/20/2015 |
| NPI Last Update Date: | 03/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 2015006040 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |