Provider Demographics
NPI:1821567587
Name:BROWN, MITZI DIANNE (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:MITZI
Middle Name:DIANNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 TAYLOR ST STE 125
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-4453
Mailing Address - Country:US
Mailing Address - Phone:941-979-6575
Mailing Address - Fax:941-564-0258
Practice Address - Street 1:223 TAYLOR ST STE 125
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4453
Practice Address - Country:US
Practice Address - Phone:941-979-6575
Practice Address - Fax:941-564-0258
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-24
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19437101YM0800X
FLRMCHI17794101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty