Healthcare Provider Details

I. General information

NPI: 1922247352
Provider Name (Legal Business Name): MANDY MICHELLE BROWN M.ED., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 UNION BELLE BLVD.
SALTILLO MS
38866-9771
US

IV. Provider business mailing address

118 WILLOW CREEK RD
SALTILLO MS
38866-9302
US

V. Phone/Fax

Practice location:
  • Phone: 662-869-3042
  • Fax: 662-869-3405
Mailing address:
  • Phone: 662-422-9220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1499
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: