Healthcare Provider Details

I. General information

NPI: 1740448026
Provider Name (Legal Business Name): JONATHAN EVERETT BROWN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 08/23/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673D OMRS/SGXW 5955 ZEAMER AVENUE
JBER AK
99506
US

IV. Provider business mailing address

673D OMRS/SGXW 5955 ZEAMER AVENUE
JBER AK
99506
US

V. Phone/Fax

Practice location:
  • Phone: 907-580-2181
  • Fax:
Mailing address:
  • Phone: 907-580-2181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1931
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC006484
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: