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NPI Code Detail

MEDICARE: JAKE SEBASTIAN BROWN

MEDICARE: JAKE SEBASTIAN BROWN
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
21041C0700XClinical Social WorkerLPCC21769CA

General Provider Information

NPI Number : 1649995143
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAKE SEBASTIAN BROWN
Provider Business Mailing Address
First Line : 12070 TELEGRAPH RD
Second Line :
City : SANTA FE SPRINGS
State : CA
Zip : 90670-3771
Country : US
Telephone Number : 562-777-7500
Fax Number :
Provider Business Practice Location Address
First Line : 12070 TELEGRAPH RD
Second Line :
City : SANTA FE SPRINGS
State : CA
Zip : 90670-3771
Country : US
Telephone Number : 562-777-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2022
Last Update Date : 06/02/2026

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Directions to “ JAKE SEBASTIAN BROWN ” Practice Location

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