Healthcare Provider Details

I. General information

NPI: 1851280564
Provider Name (Legal Business Name): SHELLEY MI NDFUL HEALING BROWN LCDC III, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 1ST AVE
MIDDLETOWN OH
45044-4117
US

IV. Provider business mailing address

1215 1ST AVE
MIDDLETOWN OH
45044-4117
US

V. Phone/Fax

Practice location:
  • Phone: 513-849-2081
  • Fax: 513-849-2071
Mailing address:
  • Phone: 513-849-2081
  • Fax: 513-849-2071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number141322
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.0015123
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: