Healthcare Provider Details

I. General information

NPI: 1770182511
Provider Name (Legal Business Name): AUDREY BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 SCHATZ POINTE DR STE 104
DAYTON OH
45459-0001
US

IV. Provider business mailing address

7905 SCHATZ POINTE DR STE 104
DAYTON OH
45459-0001
US

V. Phone/Fax

Practice location:
  • Phone: 937-952-6379
  • Fax:
Mailing address:
  • Phone: 937-952-6379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: