1679659643 NPI number — ERNEST L BRAWNER LCSW CAS

Table of content: ERNEST L BRAWNER LCSW CAS (NPI 1679659643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679659643 NPI number — ERNEST L BRAWNER LCSW CAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAWNER
Provider First Name:
ERNEST
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW CAS
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:
1679659643
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
248 CRESCENT VALLEY COURT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEY PARK
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-434-6009
Provider Business Mailing Address Fax Number:
636-946-2980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 CRAIG RD
Provider Second Line Business Practice Location Address:
STE 130
Provider Business Practice Location Address City Name:
CREVE COEUR
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-434-6009
Provider Business Practice Location Address Fax Number:
636-946-2980
Provider Enumeration Date:
10/31/2006

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: 1041C0700X , with the licence number:  SW00372 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 124868 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com