Provider Demographics
NPI:1013400829
Name:BROWN, ERIC DWAYNE
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:DWAYNE
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2661 SPARROW WAY
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-7682
Mailing Address - Country:US
Mailing Address - Phone:702-690-7782
Mailing Address - Fax:
Practice Address - Street 1:2661 SPARROW WAY
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-7682
Practice Address - Country:US
Practice Address - Phone:702-690-7782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health