Basic Information
| Provider Information | |||||||||
| NPI: | 1871776476 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | JIMMY | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | BS CADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 98528 | ||||||||
| Address2: | DEPT 401 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891938528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026716448 | ||||||||
| FaxNumber: | 7026712331 | ||||||||
| Practice Location | |||||||||
| Address1: | 6375 W CHARLESTON BLVD | ||||||||
| Address2: | A-172 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891461139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028770684 | ||||||||
| FaxNumber: | 7028772108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2007 | ||||||||
| LastUpdateDate: | 12/06/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 00187C | NV | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | 00187C | NV | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.