Healthcare Provider Details

I. General information

NPI: 1225336670
Provider Name (Legal Business Name): JEANETTE L BROWN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63139-1006
US

IV. Provider business mailing address

2811 S. KINGSHIGHWAY
ST. LOUIS MO
63139
US

V. Phone/Fax

Practice location:
  • Phone: 314-802-8805
  • Fax:
Mailing address:
  • Phone: 314-802-8805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2007008822
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: