Healthcare Provider Details

I. General information

NPI: 1083294896
Provider Name (Legal Business Name): MICKENZIE BROWN LCDC III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 CENTRAL PARK W STE 106
TOLEDO OH
43617-3009
US

IV. Provider business mailing address

3231 CENTRAL PARK W STE 106
TOLEDO OH
43617-3009
US

V. Phone/Fax

Practice location:
  • Phone: 888-442-2323
  • Fax:
Mailing address:
  • Phone: 888-442-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII.162645
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: