Healthcare Provider Details

I. General information

NPI: 1336005677
Provider Name (Legal Business Name): JILL LAUREL BROWN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S POWER RD STE 120
MESA AZ
85209-6688
US

IV. Provider business mailing address

3100 E KESLER LN
GILBERT AZ
85295-7686
US

V. Phone/Fax

Practice location:
  • Phone: 480-382-1257
  • Fax:
Mailing address:
  • Phone: 480-209-5033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-23797
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: