Provider Demographics
NPI:1922247352
Name:BROWN, MANDY MICHELLE (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:MICHELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 WILLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-9302
Mailing Address - Country:US
Mailing Address - Phone:662-422-9220
Mailing Address - Fax:
Practice Address - Street 1:110 UNION BELLE BLVD.
Practice Address - Street 2:
Practice Address - City:SALTILLO
Practice Address - State:MS
Practice Address - Zip Code:38866-9771
Practice Address - Country:US
Practice Address - Phone:662-869-3042
Practice Address - Fax:662-869-3405
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MS1499101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health