MEDICARE: MR. HERBERT LEE BROWN JR. CAC III, MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	2956	CO

General Provider Information

NPI Number	:	1215335252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HERBERT LEE BROWN JR. CAC III, MA

Provider Business Mailing Address
First Line	:	3804 W PRINCETON CIR
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80236-3111
Country	:	US
Telephone Number	:	303-333-4280
Fax Number	:	303-333-0104

Provider Business Practice Location Address
First Line	:	3804 W PRINCETON CIR
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80236-3111
Country	:	US
Telephone Number	:	303-333-4280
Fax Number	:	303-333-0104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2014
Last Update Date	:	12/08/2014

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