Provider Demographics
NPI:1245918416
Name:BROWN, ALEXANDRA (PCLC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PCLC
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 804
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:MT
Mailing Address - Zip Code:59829-0804
Mailing Address - Country:US
Mailing Address - Phone:406-381-9719
Mailing Address - Fax:
Practice Address - Street 1:3334 DVN LN
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:MT
Practice Address - Zip Code:59829-9736
Practice Address - Country:US
Practice Address - Phone:406-375-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-49570101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional