Healthcare Provider Details

I. General information

NPI: 1629352117
Provider Name (Legal Business Name): VICTORIA SCHILD BROWN DBH, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S MAIN ST STE 208
CENTERVILLE UT
84014-1840
US

IV. Provider business mailing address

3325 BOUNTIFUL BLVD
BOUNTIFUL UT
84010-4465
US

V. Phone/Fax

Practice location:
  • Phone: 801-661-2794
  • Fax:
Mailing address:
  • Phone: 801-661-2794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number360798-3501
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number360798-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: