Healthcare Provider Details

I. General information

NPI: 1740295492
Provider Name (Legal Business Name): DESERT STREAMS P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 RAMBLING RD
KALAMAZOO MI
49008-1630
US

IV. Provider business mailing address

2019 RAMBLING RD
KALAMAZOO MI
49008-1630
US

V. Phone/Fax

Practice location:
  • Phone: 269-345-0909
  • Fax: 269-345-4985
Mailing address:
  • Phone: 269-345-0909
  • Fax: 269-345-4985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. ANDREW STEVEN BROWN
Title or Position: PRESIDENT/OWNER
Credential: MA, LPC
Phone: 269-345-0909