Mary Brown, CDP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP00001919 Issued in WA

Practice address

15314 NE Dole Valley Rd
Yacolt, WA 98675-9521

Phone

(360) 260-6300

Fax

(360) 686-3966

NPI assigned

Jan 27, 2016

Last updated

Jan 27, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Larch Corrections Center

  • Prison Health Clinic/Center
  • Yacolt, WA
  • NPI 1538450911
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1453852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453852800000",
    "number": "1720445273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15314 NE DOLE VALLEY RD",
            "city": "YACOLT",
            "state": "WA",
            "postal_code": "986759521",
            "telephone_number": "360-260-6300",
            "fax_number": "360-686-3966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15314 NE DOLE VALLEY RD",
            "city": "YACOLT",
            "state": "WA",
            "postal_code": "986759521",
            "telephone_number": "360-260-6300",
            "fax_number": "360-686-3966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "MARY",
        "credential": "CDP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-27",
        "last_updated": "2016-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP00001919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenna Aiello, M.S., CCC-SLP
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• Douglas Boyce
• Mary Bruckelmyer
• Amy R Cook, CBT
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• Jennifer Lynn Foster, BCBA
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• Addiction (Substance Use Disorder) Counselor in Yacolt, WA
• Providers in Yacolt, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.