Provider Demographics
NPI:1235940644
Name:BROWN, CIERRA JADE
Entity type:Individual
Prefix:
First Name:CIERRA
Middle Name:JADE
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 1:4511 COLUMBUS AVE APT S-135
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46013-5124
Mailing Address - Country:US
Mailing Address - Phone:765-571-1294
Mailing Address - Fax:
Practice Address - Street 1:19043 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1530
Practice Address - Country:US
Practice Address - Phone:317-731-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN24-322672106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician