Healthcare Provider Details

I. General information

NPI: 1265538474
Provider Name (Legal Business Name): MARCI BROWN-GILPIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18850 E SCHOOL HOUSE RD 3
BLACK CANYON CITY AZ
85324-8787
US

IV. Provider business mailing address

PO BOX 635
BLACK CANYON CITY AZ
85324-0635
US

V. Phone/Fax

Practice location:
  • Phone: 602-819-6787
  • Fax: 815-331-5323
Mailing address:
  • Phone: 602-819-6787
  • Fax: 815-331-5323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW-10086
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: