Healthcare Provider Details

I. General information

NPI: 1174709752
Provider Name (Legal Business Name): STEVE LAMAR BROWN L.I.S.A.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 N 31ST AVE STE 200
PHOENIX AZ
85051-9565
US

IV. Provider business mailing address

15810 N 35TH AVE
PHOENIX AZ
85053-3820
US

V. Phone/Fax

Practice location:
  • Phone: 602-997-9006
  • Fax: 602-395-1764
Mailing address:
  • Phone: 866-207-3882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberLISAC-10912
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC-10912
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: