Healthcare Provider Details

I. General information

NPI: 1255961876
Provider Name (Legal Business Name): LINDA MARIE BROWN TCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 MIDLAND BLVD
SHELBYVILLE KY
40065-7791
US

IV. Provider business mailing address

213 MIDLAND BLVD
SHELBYVILLE KY
40065-7791
US

V. Phone/Fax

Practice location:
  • Phone: 502-647-0154
  • Fax: 502-633-4043
Mailing address:
  • Phone: 502-647-0154
  • Fax: 502-633-4043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number260834
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: