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General NPI Number Information
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NPI Number | 1699357582
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Entity Type | Organization
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Legal Business Name | STACEY LYN BROWN INC.
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 2152 W FARRAGUT AVE
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City | CHICAGO
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State | IL
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Zip | 60625-1204
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Country | US
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Telephone | 773-459-3136
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Fax |
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Provider Business Mailing Address
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Address Line | 820 OAKTON ST APT 5A
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City | EVANSTON
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State | IL
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Zip | 60202-2843
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Country | US
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Telephone | 773-459-3136
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Fax |
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Authorized Official
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Title or Position | OWNDER
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Name | STACEY LYN BROWN
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Credential | LCSW
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Telephone | 773-459-3136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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