Provider Demographics
NPI:1215590906
Name:BROWN HARRELL, KATRINA SHAUNAY (LPC)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:SHAUNAY
Last Name:BROWN HARRELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2968
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85380-2968
Mailing Address - Country:US
Mailing Address - Phone:480-202-9369
Mailing Address - Fax:
Practice Address - Street 1:14240 N 43RD AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4511
Practice Address - Country:US
Practice Address - Phone:602-866-8850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-16356101YM0800X
AZLPC-18784101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health