Healthcare Provider Details

I. General information

NPI: 1750594156
Provider Name (Legal Business Name): JAMES EDWARD BROWN LMFT, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15440 MUSEUM RD
BROOKINGS OR
97415-9519
US

IV. Provider business mailing address

PO BOX 7085
BROOKINGS OR
97415-0361
US

V. Phone/Fax

Practice location:
  • Phone: 541-698-6348
  • Fax:
Mailing address:
  • Phone: 541-698-6348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC3204
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT0864
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: