Healthcare Provider Details

I. General information

NPI: 1134181753
Provider Name (Legal Business Name): STEPHEN R BROWN SR. MSED, LPCC-S, LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/22/2023
Certification Date: 07/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8790 E MARKET ST SUITE 300
WARREN OH
44484-2360
US

IV. Provider business mailing address

223 W MAIN ST
RAVENNA OH
44266-2741
US

V. Phone/Fax

Practice location:
  • Phone: 330-841-1160
  • Fax: 330-841-1176
Mailing address:
  • Phone: 330-577-4099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE1892
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0014079
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: