Provider Demographics
NPI:1689126526
Name:MARTIN, BROOKE (LMHC)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DODGE ST STE 205
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-5248
Mailing Address - Country:US
Mailing Address - Phone:563-552-0255
Mailing Address - Fax:
Practice Address - Street 1:3500 DODGE ST STE 205
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-5248
Practice Address - Country:US
Practice Address - Phone:563-552-0255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2023-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IA088391101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor