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NPI Code Detail

MEDICARE: PEARL BROWN LCPC

MEDICARE: PEARL BROWN LCPC
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
1101YP2500XProfessional Counselor180.015905IL

General Provider Information

NPI Number : 1447608641
Entity Type Code : Individual
Provider Name (Legal Business Name) : PEARL BROWN LCPC
Provider Business Mailing Address
First Line : 3600 S WATER TOWER PL
Second Line :
City : MOUNT VERNON
State : IL
Zip : 62864-6589
Country : US
Telephone Number : 706-483-6926
Fax Number :
Provider Business Practice Location Address
First Line : 3600 S WATER TOWER PL
Second Line :
City : MOUNT VERNON
State : IL
Zip : 62864-6589
Country : US
Telephone Number : 706-483-6926
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2016
Last Update Date : 01/14/2025

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