MEDICARE: BONNIE BROWN COUNSELING, LLC

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	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1427332352	OTHER		CMS

General Provider Information

NPI Number	:	1811455447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BONNIE BROWN COUNSELING, LLC

Provider Business Mailing Address
First Line	:	7100 PLANTATION RD STE 11
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32504-6234
Country	:	US
Telephone Number	:	850-607-8453
Fax Number	:	850-607-6935

Provider Business Practice Location Address
First Line	:	7100 PLANTATION RD STE 11
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32504-6234
Country	:	US
Telephone Number	:	850-607-8453
Fax Number	:	850-607-6935

Authorized Official
Title or Position	:	OWNER
Name	:	MS. BONNIE BROWN
Credential	:	LCSW
Telephone Number	:	850-232-6935

Provider Enumeration Date	:	03/02/2019
Last Update Date	:	03/02/2019

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