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NPI Code Detail

MEDICARE: MR. KEVIN J BROWN

MEDICARE: MR. KEVIN J 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
1101YM0800XMental Health Counselor39001329AIN

General Provider Information

NPI Number : 1659374791
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEVIN J BROWN
Provider Business Mailing Address
First Line : 850 N HARRISON ST
Second Line :
City : WARSAW
State : IN
Zip : 46580-3163
Country : US
Telephone Number : 574-267-7169
Fax Number : 574-269-3995
Provider Business Practice Location Address
First Line : 850 N HARRISON ST
Second Line :
City : WARSAW
State : IN
Zip : 46580-3163
Country : US
Telephone Number : 574-267-7169
Fax Number : 574-269-3995
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 07/08/2007

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