Healthcare Provider Details

I. General information

NPI: 1801707633
Provider Name (Legal Business Name): JEFFRY BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 LOCKHAVEN DR NE # 505
KEIZER OR
97303-2071
US

IV. Provider business mailing address

785 STEWART ST NE
SALEM OR
97301-2517
US

V. Phone/Fax

Practice location:
  • Phone: 503-851-8585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR10262
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: