Healthcare Provider Details

I. General information

NPI: 1255695359
Provider Name (Legal Business Name): BETHANY J BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6127 FAIR OAKS BLVD
CARMICHAEL CA
95608-4818
US

IV. Provider business mailing address

310 HARRIS AVE SUITE A
SACRAMENTO CA
95838-3249
US

V. Phone/Fax

Practice location:
  • Phone: 916-974-8090
  • Fax:
Mailing address:
  • Phone: 916-649-6793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberI3950412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: