Healthcare Provider Details

I. General information

NPI: 1295413839
Provider Name (Legal Business Name): GRIFFITH WILLIAM BROWN LPC, MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15209 W MICHIGAN AVE
MARSHALL MI
49068-9570
US

IV. Provider business mailing address

200 N MADISON ST
MARSHALL MI
49068-1143
US

V. Phone/Fax

Practice location:
  • Phone: 269-781-9119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451023009
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: