Provider Demographics
NPI:1205296373
Name:BROWN, EMMA-SHIVANI (PHD, LAC)
Entity type:Individual
Prefix:DR
First Name:EMMA-SHIVANI
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD, LAC
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 200772
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-0772
Mailing Address - Country:US
Mailing Address - Phone:209-791-0957
Mailing Address - Fax:
Practice Address - Street 1:2323 S TROY ST STE 1-216
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1980
Practice Address - Country:US
Practice Address - Phone:720-979-1095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001097101YA0400X
COACD.0001097101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08-205-1021OtherDRIVER LICENSE