Provider Demographics
NPI:1497006928
Name:BROWN, MELISSA IRENE (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:IRENE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 RIVENDELL RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-5975
Mailing Address - Country:US
Mailing Address - Phone:815-715-1026
Mailing Address - Fax:
Practice Address - Street 1:4004 HILLSBORO RD STE A207
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2228
Practice Address - Country:US
Practice Address - Phone:815-723-8286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0137271041C0700X
TN81051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical