Doctor Name: | JONATHAN EVERETT BROWN |
NPI Number: | 1740448026 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | 1931 |
Business Practice Address: | 559 Vincent St Attn: 21 Mdos/sgow-mental Health Clinic Peterson Afb, CO - 809141540 |
Business Phone Number: | 7195567804 |
Business Fax Number: | 7195567399 |
Mailing Address: | 559 Vincent St, Attn: 21 Mdos/sgow-mental Health Clinic PETERSON AFB |
State: | CO |
Postal Code: | 809141540 |
Phone Number: | 7195567804 |
Fax Number: | 7195567399 |
NPI Enumeration Date: | 05/23/2008 |
NPI Last Update Date: | 02/26/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 1931 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |