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General NPI Number Information
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NPI Number | 1366591794
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Entity Type | Organization
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Legal Business Name | ELLA E M BROWN CHARITABLE CIRCLE
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 200 N MADISON ST
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City | MARSHALL
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State | MI
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Zip | 49068-1143
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Country | US
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Telephone | 269-781-9119
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Fax |
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Provider Business Mailing Address
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Address Line | 200 N MADISON ST
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City | MARSHALL
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State | MI
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Zip | 49068-1143
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Country | US
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Telephone | 269-781-4271
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | ANDREW POOLE III
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Credential |
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Telephone | 269-789-3936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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