Provider Demographics
NPI:1316013253
Name:BROWN, SALLY A. ANN (PHD, LCSW)
Entity Type:Individual
Prefix:
First Name:SALLY A.
Middle Name:ANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:MEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5465 GALENA DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-2261
Mailing Address - Country:US
Mailing Address - Phone:928-632-3332
Mailing Address - Fax:
Practice Address - Street 1:5465 GALENA DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2261
Practice Address - Country:US
Practice Address - Phone:928-632-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ167601041C0700X
NMI-061701041C0700X
AZLCSW167601041C0700X
COCSW9929101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical