Healthcare Provider Details

I. General information

NPI: 1972418457
Provider Name (Legal Business Name): WALTER BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 E MAIN ST STE 107
WHITEHALL OH
43213-2574
US

IV. Provider business mailing address

203 N NIXON AVE
LIMA OH
45805-2318
US

V. Phone/Fax

Practice location:
  • Phone: 614-604-7234
  • Fax:
Mailing address:
  • Phone: 614-604-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: