Provider Demographics
NPI:1023208535
Name:BROWN, MONTANA SKY (LCPC)
Entity Type:Individual
Prefix:MS
First Name:MONTANA
Middle Name:SKY
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CLUB CENTRE CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3503
Mailing Address - Country:US
Mailing Address - Phone:618-789-0115
Mailing Address - Fax:618-656-9084
Practice Address - Street 1:2 CLUB CENTRE CT
Practice Address - Street 2:SUITE 1
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3503
Practice Address - Country:US
Practice Address - Phone:618-789-0115
Practice Address - Fax:618-656-9084
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007283101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional