Provider Demographics
NPI:1639233968
Name:BROWN, BEVERLY J (PCC)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:J
Last Name:BROWN
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:MRS
Other - First Name:BEVERLY
Other - Middle Name:JENKINS
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, PCC
Mailing Address - Street 1:716 ADAIR AVENUE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701
Mailing Address - Country:US
Mailing Address - Phone:740-891-9000
Mailing Address - Fax:740-891-9001
Practice Address - Street 1:716 ADAIR AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2836
Practice Address - Country:US
Practice Address - Phone:740-891-9006
Practice Address - Fax:740-891-9007
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPCC#E0500043101YM0800X
OHE.0500043101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPC#E0500043OtherOHIO LICNSE NUMBER