Provider Demographics
NPI:1861753410
Name:COORLIM-HERBERT, BROOKE ELIZABETH
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:ELIZABETH
Last Name:COORLIM-HERBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BROOKE
Other - Middle Name:ELIZABETH
Other - Last Name:HERBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14600 NW CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5442
Mailing Address - Country:US
Mailing Address - Phone:503-645-3581
Mailing Address - Fax:
Practice Address - Street 1:4925 N ALBINA AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-2609
Practice Address - Country:US
Practice Address - Phone:503-548-4922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health