MEDICARE: MRS. JENNA MARJORIE BROWN

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1972048080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNA MARJORIE BROWN

Provider Business Mailing Address
First Line	:	2030 MOUNTAIN PARK DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-9281
Country	:	US
Telephone Number	:	509-991-8524
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 MOUNTAIN PARK DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-9281
Country	:	US
Telephone Number	:	509-991-8524
Fax Number	:

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

Provider Enumeration Date	:	12/28/2016
Last Update Date	:	12/28/2016

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