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NPI Code Detail

MEDICARE: MICKENZIE BROWN LCDC III

MEDICARE: MICKENZIE BROWN LCDC III
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
1175T00000XPeer Specialist
2101YM0800XMental Health Counselor
3101YA0400XAddiction (Substance Use Disorder) CounselorLCDCIII.162645OH

General Provider Information

NPI Number : 1083294896
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICKENZIE BROWN LCDC III
Provider Business Mailing Address
First Line : 3231 CENTRAL PARK W STE 106
Second Line :
City : TOLEDO
State : OH
Zip : 43617-3009
Country : US
Telephone Number : 888-442-2323
Fax Number :
Provider Business Practice Location Address
First Line : 3231 CENTRAL PARK W STE 106
Second Line :
City : TOLEDO
State : OH
Zip : 43617-3009
Country : US
Telephone Number : 888-442-2323
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2021
Last Update Date : 05/30/2025

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Directions to “ MICKENZIE BROWN LCDC III” Practice Location

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