Healthcare Provider Details

I. General information

NPI: 1063992287
Provider Name (Legal Business Name): ANDREA BROWN MS, LAC, NCAC II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 VILLAGE PL STE 203
DILLON CO
80435-6034
US

IV. Provider business mailing address

PO BOX 24591
SILVERTHORNE CO
80498
US

V. Phone/Fax

Practice location:
  • Phone: 970-406-2620
  • Fax:
Mailing address:
  • Phone: 303-565-0284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberNLC.0008064
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0001589
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: