Healthcare Provider Details

I. General information

NPI: 1184339392
Provider Name (Legal Business Name): MINDY L BROWN CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 S HOLTZCLAW AVE
CHATTANOOGA TN
37404-4804
US

IV. Provider business mailing address

4942 BRIGHTON LN
HIXSON TN
37343-4256
US

V. Phone/Fax

Practice location:
  • Phone: 901-826-2556
  • Fax:
Mailing address:
  • Phone: 901-826-2556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: