Healthcare Provider Details

I. General information

NPI: 1063332096
Provider Name (Legal Business Name): VICTORIA MARIE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3681 OSPREY DR
SIERRA VISTA AZ
85650-6643
US

IV. Provider business mailing address

3681 OSPREY DR
SIERRA VISTA AZ
85650-6643
US

V. Phone/Fax

Practice location:
  • Phone: 910-745-5161
  • Fax:
Mailing address:
  • Phone: 910-745-5161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number20336733
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: