MEDICARE: JONATHAN RAY BROWN MA, LH

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	101YP2500X	Professional Counselor	LH60428138	WA
2	101YM0800X	Mental Health Counselor	LH60428138	WA

General Provider Information

NPI Number	:	1568614931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN RAY BROWN MA, LH

Provider Business Mailing Address
First Line	:	160 NW GILMAN BLVD STE 308
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-2549
Country	:	US
Telephone Number	:	425-395-4340
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 NW GILMAN BLVD STE 308
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-2549
Country	:	US
Telephone Number	:	425-395-4340
Fax Number	:

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

Provider Enumeration Date	:	10/16/2008
Last Update Date	:	09/14/2020

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