Provider Demographics
NPI:1326739277
Name:BROWN, CAROLYN KEELER
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:KEELER
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 PARK LN
Mailing Address - Street 2:
Mailing Address - City:GOLF
Mailing Address - State:IL
Mailing Address - Zip Code:60029-3108
Mailing Address - Country:US
Mailing Address - Phone:847-452-2393
Mailing Address - Fax:
Practice Address - Street 1:54 PARK LN
Practice Address - Street 2:
Practice Address - City:GOLF
Practice Address - State:IL
Practice Address - Zip Code:60029-3108
Practice Address - Country:US
Practice Address - Phone:847-452-2393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178010273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health