Provider Demographics
NPI:1134479298
Name:BROWN, DUSTIN D SR
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:D
Last Name:BROWN
Suffix:SR
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 1:3204 ORCHARD AVE.
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012
Mailing Address - Country:US
Mailing Address - Phone:405-343-4993
Mailing Address - Fax:
Practice Address - Street 1:3204 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-9645
Practice Address - Country:US
Practice Address - Phone:405-343-4993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst