Healthcare Provider Details

I. General information

NPI: 1942158639
Provider Name (Legal Business Name): TRACI JO BROWN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 N 3RD ST
PHOENIX AZ
85012-2331
US

IV. Provider business mailing address

4731 W GELDING DR
GLENDALE AZ
85306-4444
US

V. Phone/Fax

Practice location:
  • Phone: 602-265-8338
  • Fax:
Mailing address:
  • Phone: 602-460-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC24630
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: