Provider Demographics
NPI:1366824559
Name:BROWN, EMILY MICHELE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:MICHELE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:MICHELE
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:P O BOX 516
Mailing Address - Street 2:11020 STATE ROUTE 250
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62439
Mailing Address - Country:US
Mailing Address - Phone:618-943-3754
Mailing Address - Fax:618-943-3657
Practice Address - Street 1:11020 STATE ROUTE 250
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62439
Practice Address - Country:US
Practice Address - Phone:618-943-3754
Practice Address - Fax:618-943-3657
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL376006178Medicaid
IL376006178Medicaid
IL207184Medicare PIN