Glenn Wanden Brooks Jr.

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

136527 Issued in CA

Practice address

790 S State St
San Jacinto, CA 92583-4926

Phone

(951) 623-6728

NPI assigned

Mar 23, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1154024834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "377 RECOGNITION LN",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925712907",
            "telephone_number": "951-623-6728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 S STATE ST",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925834926",
            "telephone_number": "951-623-6728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "GLENN",
        "middle_name": "WANDEN",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-23",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "136527",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenrick Carlyle Bourne, PA-C
• Laura Beth Bradford, NP
• Stephanie Brane
• Gerson Yestin Bravo, LMFT, APCC
• Bright Paths Ahead, Inc
• Stephanie Bruce, PH.D
• David Lawrence Brunken, ATC
• Java Lynn Buchanan, RRW
• Theresa Elizabeth Bullard, C A S II
• Cal Hospice Care Facility

• All providers in San Jacinto, CA
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.