Healthcare Provider Details

I. General information

NPI: 1811900905
Provider Name (Legal Business Name): DAVID L BROWN LPC MHSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HOLSTON DR NOLACHUCKEY MENTAL HEALTH CENTER FRONTIER HEALTH
GREENEVILLE TN
37743
US

IV. Provider business mailing address

1167 SPRATLIN PARK DRIVE
GRAY TN
37615-6205
US

V. Phone/Fax

Practice location:
  • Phone: 423-639-1104
  • Fax: 423-636-8365
Mailing address:
  • Phone: 423-467-3600
  • Fax: 423-467-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC1533
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1533
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: