MEDICARE: LOLA BROWN PSCII

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

General Provider Information

NPI Number	:	1386860989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOLA BROWN PSCII

Provider Business Mailing Address
First Line	:	1080 MARINA VILLAGE PKWY
Second Line	:	SUITE 100
City	:	ALAMEDA
State	:	CA
Zip	:	94501-6427
Country	:	US
Telephone Number	:	510-337-7950
Fax Number	:	510-337-7969

Provider Business Practice Location Address
First Line	:	400 S 4TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6201
Country	:	US
Telephone Number	:	888-879-9786
Fax Number	:

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	08/07/2019

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