Healthcare Provider Details

I. General information

NPI: 1811029945
Provider Name (Legal Business Name): DESIREE RODANN BROWN-DAUGHTRY LCSW,LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11103 PARK RD
LOUISVILLE KY
40223-2424
US

IV. Provider business mailing address

10401 LINN STATION RD STE 100
LOUISVILLE KY
40223-3842
US

V. Phone/Fax

Practice location:
  • Phone: 502-245-4171
  • Fax:
Mailing address:
  • Phone: 502-589-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number267986
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number256109
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: