Healthcare Provider Details

I. General information

NPI: 1053045476
Provider Name (Legal Business Name): CHARLEIGH BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARLEIGH DANKS

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 W HARRISON ST
SULLIVAN IL
61951-1907
US

IV. Provider business mailing address

12 W HARRISON ST
SULLIVAN IL
61951-1907
US

V. Phone/Fax

Practice location:
  • Phone: 217-728-4358
  • Fax:
Mailing address:
  • Phone: 217-728-4358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: