Provider Demographics
NPI:1134459605
Name:BROWN, MARK CURTIS
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CURTIS
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 1:1708 MEADOW RUN DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-0804
Mailing Address - Country:US
Mailing Address - Phone:580-353-9580
Mailing Address - Fax:
Practice Address - Street 1:1708 MEADOW RUN DR
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-0804
Practice Address - Country:US
Practice Address - Phone:580-353-9580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health