Organization
BROOKSGATE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELE LYNN BROOKS RD, LD, CDE (DIETITIAN, CDE)
(806) 252-1507
Entity
Organization
Contact information
Practice address
6829 6TH ST, LUBBOCK, TX 79416-3769
(806) 252-1507
(806) 785-4929
Mailing address
PO BOX 16881, LUBBOCK, TX 79490-6881
(806) 252-1507
(806) 785-4929
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT07317
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8D3218
MEDICARE ID - TYPE UNSPECIFIED
TX
Enumeration date
01/13/2012
Last updated
01/13/2012
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