Provider Demographics
NPI:1164174470
Name:BROWN, MARCELINE A (CMHC)
Entity Type:Individual
Prefix:
First Name:MARCELINE
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:MARCELINE
Other - Middle Name:
Other - Last Name:ANGLIN-BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMHC
Mailing Address - Street 1:649 E WILLIAMSBURG PARK CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-0538
Mailing Address - Country:US
Mailing Address - Phone:801-510-6529
Mailing Address - Fax:
Practice Address - Street 1:649 E WILLIAMSBURG PARK CIR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-0538
Practice Address - Country:US
Practice Address - Phone:801-510-6529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4909110-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health