MEDICARE: CATHY MARIA BROWN MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1073789657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHY MARIA BROWN MS

Provider Business Mailing Address
First Line	:	201 N BROADWAY ST STE 213
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-5135
Country	:	US
Telephone Number	:	405-990-0816
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 N BROADWAY ST STE 213
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-5135
Country	:	US
Telephone Number	:	405-990-0816
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	05/17/2016

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