MEDICARE: MS. MARCI BROWN-GILPIN LCSW

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	101YM0800X	Mental Health Counselor	LCSW-10086	AZ

General Provider Information

NPI Number	:	1265538474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCI BROWN-GILPIN LCSW

Provider Business Mailing Address
First Line	:	PO BOX 635
Second Line	:
City	:	BLACK CANYON CITY
State	:	AZ
Zip	:	85324-0635
Country	:	US
Telephone Number	:	602-819-6787
Fax Number	:	815-331-5323

Provider Business Practice Location Address
First Line	:	18850 E SCHOOL HOUSE RD
Second Line	:	3
City	:	BLACK CANYON CITY
State	:	AZ
Zip	:	85324-8787
Country	:	US
Telephone Number	:	602-819-6787
Fax Number	:	815-331-5323

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	05/10/2011

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