Healthcare Provider Details

I. General information

NPI: 1063094639
Provider Name (Legal Business Name): MICHELLE MARIE BROWN BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE MARIE TAYLOR CADC-I

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5584 S FORT APACHE RD
LAS VEGAS NV
89148-7657
US

IV. Provider business mailing address

843 PALO VERDE DR
HENDERSON NV
89015-5736
US

V. Phone/Fax

Practice location:
  • Phone: 702-296-1222
  • Fax: 888-506-8728
Mailing address:
  • Phone: 702-722-8017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number07238-I
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: