Provider Demographics
NPI:1528616224
Name:BROWN, EDYTHE ANNETTE (LMFT)
Entity type:Individual
Prefix:
First Name:EDYTHE
Middle Name:ANNETTE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26861 BLOOMFIELD DR S
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4403
Mailing Address - Country:US
Mailing Address - Phone:810-964-5195
Mailing Address - Fax:
Practice Address - Street 1:436 S SAGINAW ST STE 300
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-1830
Practice Address - Country:US
Practice Address - Phone:810-964-5195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101007316106H00000X
MI4151000523106H00000X
MI4101006885106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist