Provider Demographics
NPI:1912421371
Name:BROWN, SAMANTHA RAE (LPCCS, LCDC III, NCC)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:RAE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPCCS, LCDC III, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2113
Mailing Address - Country:US
Mailing Address - Phone:216-307-3919
Mailing Address - Fax:
Practice Address - Street 1:1551 WINCHESTER DR
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2113
Practice Address - Country:US
Practice Address - Phone:216-307-3919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2023-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2202719101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty