Provider Demographics
NPI:1043998446
Name:BREWER, JAMES EVAN
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EVAN
Last Name:BREWER
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 1:286 PIRATES COVE LN
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-9608
Mailing Address - Country:US
Mailing Address - Phone:740-417-6774
Mailing Address - Fax:
Practice Address - Street 1:263 HUNTSVILLE QUALITY RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261-7395
Practice Address - Country:US
Practice Address - Phone:270-516-1601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health