Healthcare Provider Details

I. General information

NPI: 1235858846
Provider Name (Legal Business Name): AMANDA BROWN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 N MERRILL AVE
GLENDIVE MT
59330-2062
US

IV. Provider business mailing address

306 LINDEN AVE
GLENDIVE MT
59330-3031
US

V. Phone/Fax

Practice location:
  • Phone: 406-377-6075
  • Fax:
Mailing address:
  • Phone: 406-359-9349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberBBH-LCSW-LIC-75355
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: