Provider Demographics
NPI:1659746063
Name:BROWN, CARMEL (LCPC)
Entity Type:Individual
Prefix:
First Name:CARMEL
Middle Name:
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 1:6400 WEST MAIN
Mailing Address - Street 2:SUITE 3F
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223
Mailing Address - Country:US
Mailing Address - Phone:618-717-2732
Mailing Address - Fax:618-489-1020
Practice Address - Street 1:6400 WEST MAIN SUITE 3F
Practice Address - Street 2:SUITE 3F
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223
Practice Address - Country:US
Practice Address - Phone:618-717-2732
Practice Address - Fax:618-489-1020
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IL180006399101YM0800X, 106H00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist