MEDICARE: LISA BROWN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor		IL
2	101Y00000X	Counselor	180.016145	IL

General Provider Information

NPI Number	:	1063099695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BROWN

Provider Business Mailing Address
First Line	:	1461 W 112TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4368
Country	:	US
Telephone Number	:	619-772-0297
Fax Number	:

Provider Business Practice Location Address
First Line	:	1461 W 112TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4368
Country	:	US
Telephone Number	:	312-646-0734
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2021
Last Update Date	:	12/27/2024

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Directions to “ LISA BROWN ” Practice Location

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