Basic Information
| Provider Information | |||||||||
| NPI: | 1821508698 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | CALIE | ||||||||
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| Credential: | LAC, LPC, LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1720 BURNT BOAT DR | ||||||||
| Address2: | |||||||||
| City: | BISMARCK | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585030801 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 107 W MAIN AVE STE 350 | ||||||||
| Address2: | |||||||||
| City: | BISMARCK | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585013893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006278220 | ||||||||
| FaxNumber: | 6519250057 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2017 | ||||||||
| LastUpdateDate: | 05/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 1804 | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 984-12-01-18A | ND | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 984-12-01-18-411 | ND | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.