Healthcare Provider Details

I. General information

NPI: 1275932014
Provider Name (Legal Business Name): THOMAS E BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 MADISON ST
EVERETT WA
98203-4543
US

IV. Provider business mailing address

580 ELLIS RD S STE 118
JACKSONVILLE FL
32254-3567
US

V. Phone/Fax

Practice location:
  • Phone: 425-212-4200
  • Fax: 425-212-4201
Mailing address:
  • Phone: 904-745-0067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCAAR.CG.60500645
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberCAAR.CG.60500645
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberCAAR.CG.60500645
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: