Healthcare Provider Details

I. General information

NPI: 1811771082
Provider Name (Legal Business Name): MONARCH EMOTIONAL SELF-MASTERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 09/29/2024
Certification Date: 09/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 20TH STREET NORTH STE. 1220-1026
BIRMINGHAM AL
35203-5028
US

IV. Provider business mailing address

505 20TH STREET NORTH STE. 1220-1026
BIRMINGHAM AL
35203-5028
US

V. Phone/Fax

Practice location:
  • Phone: 205-202-9390
  • Fax:
Mailing address:
  • Phone: 205-202-9390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JERUSALEM BROWN
Title or Position: PSYCHOTHERAPIST
Credential: LPC, NCC
Phone: 205-202-9390