MEDICARE: MS. CHERYL LEE BROWN LPC

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	CO648	OR

General Provider Information

NPI Number	:	1306963129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERYL LEE BROWN LPC

Provider Business Mailing Address
First Line	:	1701 NE BEVERLY DR
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-3518
Country	:	US
Telephone Number	:	541-472-1660
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 NW BEVERLY DR
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-3518
Country	:	US
Telephone Number	:	541-472-1660
Fax Number	:

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

Provider Enumeration Date	:	03/25/2007
Last Update Date	:	09/12/2014

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