Active NPI
Kenneth Brooks
- Addiction (Substance Use Disorder) Counselor
- Columbus, OH
National Provider Identifier
1083286124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- CDCA.177638
- Practice address
- 360 S Grant Ave
Columbus, OH 43215-5537 - Phone
- (614) 398-3470
- NPI assigned
- Jul 16, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CDCA.177638 | OH | Primary |
Addresses
Primary practice location
360 S Grant Ave
Columbus, OH 43215-5537
Mailing address
360 S Grant Ave
Columbus, OH 43215-5537
Phone (614) 398-3470
Other practice location 1
360 S Grant Ave
Columbus, OH 43215-5537
Phone (614) 398-3470
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CDCA.177638 | Medicaid | OH |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kennethbrooks@edencounselingcenters.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CDCA.177638 | OH | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626393600000",
"number": "1083286124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "360 S GRANT AVE",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432155537",
"telephone_number": "614-398-3470"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "360 S GRANT AVE",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432155537",
"telephone_number": "614-398-3470"
}
],
"practiceLocations": [
{
"address_1": "360 S Grant Ave",
"address_purpose": "LOCATION",
"city": "Columbus",
"state": "OH",
"postal_code": "432155537",
"country_code": "US",
"telephone_number": "614-398-3470",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BROOKS",
"first_name": "KENNETH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-16",
"last_updated": "2021-07-16",
"certification_date": "2021-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "CDCA.177638",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "CDCA.177638",
"state": "OH"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kennethbrooks@edencounselingcenters.com",
"affiliation": "N",
"endpointDescription": "kennethbrooks@edencounselingcenters.com",
"address_1": "360 S Grant Ave",
"city": "Columbus",
"state": "OH",
"country_code": "US",
"postal_code": "432155537",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.