Provider Demographics
NPI:1578654216
Name:BROWN, PATRICIA MARIE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCPC
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 275
Mailing Address - Street 2:350 WATER STREET
Mailing Address - City:WELDON
Mailing Address - State:IL
Mailing Address - Zip Code:61882-0275
Mailing Address - Country:US
Mailing Address - Phone:217-736-2967
Mailing Address - Fax:
Practice Address - Street 1:3040 N UNIVERSITY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-1391
Practice Address - Country:US
Practice Address - Phone:217-872-1700
Practice Address - Fax:217-872-1366
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional