Healthcare Provider Details

I. General information

NPI: 1407765274
Provider Name (Legal Business Name): TASHA LATRECE BROWN ASW128458
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17151 MAIN ST STE C
HESPERIA CA
92345-6191
US

IV. Provider business mailing address

13432 FAWNCREEK ST
VICTORVILLE CA
92395-8663
US

V. Phone/Fax

Practice location:
  • Phone: 760-695-6006
  • Fax: 760-998-2038
Mailing address:
  • Phone: 760-662-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW128458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: