Healthcare Provider Details

I. General information

NPI: 1629551858
Provider Name (Legal Business Name): ALYSSA JOY BROWN PHD, HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11216 FALL CREEK RD STE 9
INDIANAPOLIS IN
46256-9406
US

IV. Provider business mailing address

14672 EDGEBROOK DR
FISHERS IN
46040-1361
US

V. Phone/Fax

Practice location:
  • Phone: 317-647-4721
  • Fax: 317-647-4398
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number20043345B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: