Basic Information
| Provider Information | |||||||||
| NPI: | 1275932014 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | E | ||||||||
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| Mailing Information | |||||||||
| Address1: | 580 ELLIS RD S STE 118 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322543567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047450067 | ||||||||
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| Practice Location | |||||||||
| Address1: | 811 MADISON ST | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982034543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252124200 | ||||||||
| FaxNumber: | 4252124201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2014 | ||||||||
| LastUpdateDate: | 03/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | CAAR.CG.60500645 | WA | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | WA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 3104A0625X | CAAR.CG.60500645 | WA | N | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness | 320600000X | CAAR.CG.60500645 | WA | N | Residential Treatment Facilities | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 101YM0800X | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.