Provider Demographics
NPI:1154841047
Name:BROWN, SHAVON MARIE
Entity Type:Individual
Prefix:
First Name:SHAVON
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 ECOLS ST N
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:OR
Mailing Address - Zip Code:97361-1402
Mailing Address - Country:US
Mailing Address - Phone:503-689-3342
Mailing Address - Fax:
Practice Address - Street 1:335 ECOLS ST N
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:OR
Practice Address - Zip Code:97361-1402
Practice Address - Country:US
Practice Address - Phone:503-689-3342
Practice Address - Fax:503-689-3342
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)