Provider Demographics
NPI:1144312356
Name:BROWN, KIMBERLY ANN (MA,LPC,CAADC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA,LPC,CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7667 S GARLOCK RD
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811-9563
Mailing Address - Country:US
Mailing Address - Phone:989-584-3571
Mailing Address - Fax:
Practice Address - Street 1:507 S NELSON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-2197
Practice Address - Country:US
Practice Address - Phone:616-754-9420
Practice Address - Fax:616-754-9419
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005661101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1715928Medicaid