Healthcare Provider Details

I. General information

NPI: 1629413638
Provider Name (Legal Business Name): ANGEL C BROWN M.S. CLINICAL HEALTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 S JONES BLVD # D3
LAS VEGAS NV
89103-3370
US

IV. Provider business mailing address

9764 CORNWALL CROSSING LN
LAS VEGAS NV
89147-6743
US

V. Phone/Fax

Practice location:
  • Phone: 702-991-3150
  • Fax: 866-658-4052
Mailing address:
  • Phone: 856-340-3849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number104100000X
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number104100000X
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: