Healthcare Provider Details

I. General information

NPI: 1962868604
Provider Name (Legal Business Name): ALEXIS LAUREN BROWN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 SW LINNEMAN CT
GRESHAM OR
97030-6483
US

IV. Provider business mailing address

761 SW LINNEMAN CT
GRESHAM OR
97030-6483
US

V. Phone/Fax

Practice location:
  • Phone: 575-574-0464
  • Fax:
Mailing address:
  • Phone: 575-574-0464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL11465
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: