Provider Demographics
NPI:1174660328
Name:BROWN, BARRY LEE I (NONE)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:LEE
Last Name:BROWN
Suffix:I
Gender:M
Credentials:NONE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 SW CHAPMAN ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:OR
Mailing Address - Zip Code:97378-1604
Mailing Address - Country:US
Mailing Address - Phone:971-241-5625
Mailing Address - Fax:503-363-4820
Practice Address - Street 1:3325 HAROLD DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1339
Practice Address - Country:US
Practice Address - Phone:503-540-5571
Practice Address - Fax:503-363-4820
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR07-P-09171M00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)