Provider Demographics
NPI:1114419751
Name:BROWN, KEN N (LMFT)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:N
Last Name:BROWN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:HOPE
Other - Middle Name:
Other - Last Name:COUNSELING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:130 S INDIAN RIVER DR STE 301
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4353
Mailing Address - Country:US
Mailing Address - Phone:772-429-3334
Mailing Address - Fax:866-463-2413
Practice Address - Street 1:130 S INDIAN RIVER DR STE 301
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4353
Practice Address - Country:US
Practice Address - Phone:772-429-3334
Practice Address - Fax:866-463-2413
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1805101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE260141920OtherBEHAVIOR AND MENTAL HEALTH