MEDICARE: BERTHINIA ALICIA BROWN LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	11761	TX

General Provider Information

NPI Number	:	1467106310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERTHINIA ALICIA BROWN LCDC

Provider Business Mailing Address
First Line	:	9714 S GESSNER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-1004
Country	:	US
Telephone Number	:	346-471-3791
Fax Number	:

Provider Business Practice Location Address
First Line	:	9714 S GESSNER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-1004
Country	:	US
Telephone Number	:	346-471-3791
Fax Number	:

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

Provider Enumeration Date	:	02/09/2022
Last Update Date	:	02/09/2022

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