Provider Demographics
NPI:1538392584
Name:BRISCOE, BROOKE CORLYNNE (MFT)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:CORLYNNE
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:CORLYNNE
Other - Last Name:LUEBKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:1716 FORDEM AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4604
Mailing Address - Country:US
Mailing Address - Phone:608-221-3511
Mailing Address - Fax:608-221-3514
Practice Address - Street 1:1716 FORDEM AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4604
Practice Address - Country:US
Practice Address - Phone:608-221-3511
Practice Address - Fax:608-221-3514
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI835-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1538392584Medicaid