Basic Information
| Provider Information | |||||||||
| NPI: | 1255083184 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | MICAELA | ||||||||
| MiddleName: | DANIELLE | ||||||||
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| Credential: | LPC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14151 MONTFORT DR APT 275 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752543065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729719559 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3208 EMORY DR | ||||||||
| Address2: | |||||||||
| City: | FLOWER MOUND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750224861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6127569107 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2022 | ||||||||
| LastUpdateDate: | 01/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 83117 | TX | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.