Healthcare Provider Details

I. General information

NPI: 1134944192
Provider Name (Legal Business Name): EMMA CAROL BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 DAVIS ST
EVANSTON IL
60201-3608
US

IV. Provider business mailing address

906 DAVIS ST
EVANSTON IL
60201-3608
US

V. Phone/Fax

Practice location:
  • Phone: 847-492-1778
  • Fax:
Mailing address:
  • Phone: 847-492-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.033064
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2608052
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: