Provider Demographics
NPI:1700486420
Name:BROWN, MICHELLE ANTIONETTE (PLMHP, PMSW)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:ANTIONETTE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PLMHP, PMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 N 126TH CT APT 206
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-1884
Mailing Address - Country:US
Mailing Address - Phone:402-609-6876
Mailing Address - Fax:
Practice Address - Street 1:11071 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-2604
Practice Address - Country:US
Practice Address - Phone:402-932-8884
Practice Address - Fax:402-932-8885
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE74361041C0700X
NE12098101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical