MEDICARE: ALICIA BROWN LMFT

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	106H00000X	Marriage & Family Therapist	4291	FL
2	101YP1600X	Pastoral Counselor	4291	FL

General Provider Information

NPI Number	:	1124753017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA BROWN LMFT

Provider Business Mailing Address
First Line	:	3041 WENTWORTH PL
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-2087
Country	:	US
Telephone Number	:	863-801-6176
Fax Number	:

Provider Business Practice Location Address
First Line	:	3041 WENTWORTH PL
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-2087
Country	:	US
Telephone Number	:	863-801-6176
Fax Number	:

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

Provider Enumeration Date	:	07/23/2022
Last Update Date	:	09/10/2023

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Directions to “ ALICIA BROWN LMFT” Practice Location

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