Provider Demographics
NPI:1700925666
Name:BROWNFIELD, MICHAELENE KAY (MA, LCPC, NCC)
Entity Type:Individual
Prefix:
First Name:MICHAELENE
Middle Name:KAY
Last Name:BROWNFIELD
Suffix:
Gender:F
Credentials:MA, LCPC, NCC
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 1387
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-1387
Mailing Address - Country:US
Mailing Address - Phone:208-769-4222
Mailing Address - Fax:844-803-7399
Practice Address - Street 1:2201 N IRONWOOD PL STE 100
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2670
Practice Address - Country:US
Practice Address - Phone:208-769-4222
Practice Address - Fax:844-803-7399
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4505101Y00000X, 101YP2500X
NE474101YM0800X
MT4583101YP2500X
NE1529101YP2500X
ID8317101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200331430AMedicaid