Provider Demographics
NPI:1558488890
Name:BROWN, BRANDI CHRISTINE (LSW)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:CHRISTINE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 354
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:47424-0354
Mailing Address - Country:US
Mailing Address - Phone:812-381-3606
Mailing Address - Fax:812-384-8263
Practice Address - Street 1:65 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IN
Practice Address - Zip Code:47460-1729
Practice Address - Country:US
Practice Address - Phone:812-381-3606
Practice Address - Fax:812-384-8263
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4792S101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health