Provider Demographics
NPI:1780239715
Name:BROWN, VANESSA ELLE
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ELLE
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 1:5168 N BLYTHE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-6478
Mailing Address - Country:US
Mailing Address - Phone:559-255-5900
Mailing Address - Fax:559-981-1212
Practice Address - Street 1:5168 N BLYTHE AVE STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-6478
Practice Address - Country:US
Practice Address - Phone:559-255-5900
Practice Address - Fax:559-981-1212
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100003AN101YA0400X
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)