1811900905 NPI number — MR. DAVID L BROWN LPC MHSP

Table of content: MR. DAVID L BROWN LPC MHSP (NPI 1811900905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811900905 NPI number — MR. DAVID L BROWN LPC MHSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
DAVID
Provider Middle Name:
L
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC MHSP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811900905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1167 SPRATLIN PARK DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37615-6205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-467-3600
Provider Business Mailing Address Fax Number:
423-467-3644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 HOLSTON DR
Provider Second Line Business Practice Location Address:
NOLACHUCKEY MENTAL HEALTH CENTER FRONTIER HEALTH
Provider Business Practice Location Address City Name:
GREENEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-639-1104
Provider Business Practice Location Address Fax Number:
423-636-8365
Provider Enumeration Date:
08/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  LPC1533 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 1533 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4098479 . This is a "MAGELLAN PINNACLE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "CARITEN PHP POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "CARITEN PHP HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 021 . This is a "TRICARE SOUTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "CARITEN PHP PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 334969 . This is a "VALUE OPTIONS GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4098479 . This is a "MAGELLAN SUMMIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "CARITEN SENIOR PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "MENTAL HEALTH NETW" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4098479 . This is a "MAGELLAN NAVIGATOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "INITIAL GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "CARITEN SENIOR HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "CORPHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 351654200 . This is a "DOL WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 290298 . This is a "MANAGED HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "THREE RIVERS PROVI GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "CAR PHP MEDICARE H" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "CAR PHP LEASE PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "CARITEN PHP WORKCO" identifier . This identifiers is of the category "OTHER".




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