Healthcare Provider Details

I. General information

NPI: 1023849502
Provider Name (Legal Business Name): MIKA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHIELDS AVE
DAVIS CA
95616-5270
US

IV. Provider business mailing address

3721 E COMMERCE WAY APT 3415
SACRAMENTO CA
95834-4057
US

V. Phone/Fax

Practice location:
  • Phone: 530-752-2300
  • Fax:
Mailing address:
  • Phone: 858-947-8618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: