Provider Demographics
NPI:1346436284
Name:BROWN, BERNADETTE M (MS, PC, NCC)
Entity Type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS, PC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 SMUGGLERS WAY
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-5856
Mailing Address - Country:US
Mailing Address - Phone:937-609-3924
Mailing Address - Fax:937-433-0593
Practice Address - Street 1:1374 N. FAIRFIELD RD.
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2644
Practice Address - Country:US
Practice Address - Phone:937-427-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2008-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0600573101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
235836OtherNATIONAL BOARD FOR CERTIFIED COUNSELORS
OHC0600573OtherSTATE OF OHIO COUNSELOR, SOCIAL WORKER, MARRIAGE & FAMILY THERAPIST BOARD