Basic Information
| Provider Information | |||||||||
| NPI: | 1700925666 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWNFIELD | ||||||||
| FirstName: | MICHAELENE | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | MA, LCPC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1387 | ||||||||
| Address2: | |||||||||
| City: | HAYDEN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838351387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087694222 | ||||||||
| FaxNumber: | 8448037399 | ||||||||
| Practice Location | |||||||||
| Address1: | 2201 N IRONWOOD PL STE 100 | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838142670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087694222 | ||||||||
| FaxNumber: | 8448037399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 10/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 4505 | OK | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | 474 | NE | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 4583 | MT | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 4505 | OK | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 1529 | NE | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 8317 | ID | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.