Healthcare Provider Details

I. General information

NPI: 1376463158
Provider Name (Legal Business Name): GRANT HOWARD BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10121 EVERGREEN WY #25-225
EVERETT WA
98204-3878
US

IV. Provider business mailing address

11030 EVERGREEN WAY APT D309
EVERETT WA
98204-6647
US

V. Phone/Fax

Practice location:
  • Phone: 208-818-1155
  • Fax:
Mailing address:
  • Phone: 208-818-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCBT.CB.70159831
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: