Healthcare Provider Details

I. General information

NPI: 1730099763
Provider Name (Legal Business Name): COLLEEN RENAE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

6150 PARK SQUARE DR
LORAIN OH
44053-4153
US

IV. Provider business mailing address

6192 W MEADOW FARM LN
LORAIN OH
44053-4361
US

V. Phone/Fax

Practice location:
  • Phone: 440-384-8601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: