Healthcare Provider Details

I. General information

NPI: 1306662796
Provider Name (Legal Business Name): KIMBERLY NICHOLE BROWN LPC/MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 OVERLOOK CIR STE 200
BRENTWOOD TN
37027-8508
US

IV. Provider business mailing address

8421 CALLABEE WAY UNIT 2
ANTIOCH TN
37013-4625
US

V. Phone/Fax

Practice location:
  • Phone: 615-200-7327
  • Fax:
Mailing address:
  • Phone: 615-200-7327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC0000006824
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC0000006824
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: