Provider Demographics
NPI:1487429015
Name:BROWN, AUDREY RUTH
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:RUTH
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 OFARRELL ST
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-2036
Mailing Address - Country:US
Mailing Address - Phone:316-494-1482
Mailing Address - Fax:
Practice Address - Street 1:300 OFARRELL ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-2036
Practice Address - Country:US
Practice Address - Phone:316-494-1482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health