Provider Demographics
NPI:1902043359
Name:BROOKS, ALAN WAYNE (LMFT)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:WAYNE
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 QUINCY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1906
Mailing Address - Country:US
Mailing Address - Phone:801-334-7798
Mailing Address - Fax:
Practice Address - Street 1:3670 QUINCY AVE STE 101
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1906
Practice Address - Country:US
Practice Address - Phone:801-334-7798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT330263-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist