1730570151 NPI number — NICOLE BROWN LPC

Table of content: NICOLE BROWN LPC (NPI 1730570151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730570151 NPI number — NICOLE BROWN LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
NICOLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VASHON
Provider Other First Name:
NICOLE
Provider Other Middle Name:
BROWN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LLP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1730570151
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2215 29TH ST SE STE B8A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49508-1565
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-690-5396
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 WASHINGTON AVE STE 320
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND HAVEN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49417-1378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-690-5396
Provider Business Practice Location Address Fax Number:
616-404-7004
Provider Enumeration Date:
02/06/2015

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:  6401017587 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CV0154400 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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