Healthcare Provider Details

I. General information

NPI: 1124151444
Provider Name (Legal Business Name): JEANA BROWN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 E SOUTHERN AVE
MESA AZ
85206-2569
US

IV. Provider business mailing address

2153 W PINKLEY AVE
COOLIDGE AZ
85128-8204
US

V. Phone/Fax

Practice location:
  • Phone: 704-998-1101
  • Fax:
Mailing address:
  • Phone: 704-998-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC23173
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: