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General NPI Number Information
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NPI Number | 1629379474
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Entity Type | Organization
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Legal Business Name | BROWNHARDT LLC
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Dates
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Enumeration Date | 11/10/2010
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Last Update Date | 11/10/2010
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Provider Practice Location Address
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Address Line | 445 W JACKSON AVE SUITE 107
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City | NAPERVILLE
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State | IL
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Zip | 60540-5256
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Country | US
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Telephone | 630-890-9680
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Fax | 630-689-9484
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Provider Business Mailing Address
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Address Line | 9930 W 190TH ST SUITE L
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City | MOKENA
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State | IL
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Zip | 60448-5608
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Country | US
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Telephone | 630-890-9680
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Fax | 630-689-9484
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Authorized Official
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Title or Position | FOUNDER
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Name | MARC BROWNING
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Credential | PSY.D.
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Telephone | 630-890-9680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071007887
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License Number State | IL
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