MEDICARE: MAHOGANY BROWN

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	:	1639843204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHOGANY BROWN

Provider Business Mailing Address
First Line	:	5363 HOLLY SPRINGS DR W
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-4272
Country	:	US
Telephone Number	:	317-909-4885
Fax Number	:

Provider Business Practice Location Address
First Line	:	3073 SALT LAKE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-1432
Country	:	US
Telephone Number	:	317-296-4187
Fax Number	:

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

Provider Enumeration Date	:	08/05/2021
Last Update Date	:	08/05/2021

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Directions to “ MAHOGANY BROWN ” Practice Location

Language	Start Address	Practice Location

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