Provider Demographics
NPI:1063094639
Name:BROWN, MICHELLE MARIE (BA)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC-I
Mailing Address - Street 1:843 PALO VERDE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-5736
Mailing Address - Country:US
Mailing Address - Phone:702-722-8017
Mailing Address - Fax:
Practice Address - Street 1:1536 N BOULDER HWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-4120
Practice Address - Country:US
Practice Address - Phone:702-558-8600
Practice Address - Fax:702-558-8700
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV07238-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)