Healthcare Provider Details

I. General information

NPI: 1558645218
Provider Name (Legal Business Name): RYAN JAMES BROWN MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 US HIGHWAY 23 N
ALPENA MI
49707-8004
US

IV. Provider business mailing address

154 S RIPLEY BLVD
ALPENA MI
49707-3406
US

V. Phone/Fax

Practice location:
  • Phone: 989-356-4049
  • Fax:
Mailing address:
  • Phone: 989-356-6385
  • Fax: 989-356-4909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: