Provider Demographics
NPI:1215575931
Name:BROWN, BRIAN CHRISTIAN (LADC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:CHRISTIAN
Last Name:BROWN
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12020 SHAMROCK PLZ STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3537
Mailing Address - Country:US
Mailing Address - Phone:402-953-9180
Mailing Address - Fax:
Practice Address - Street 1:12020 SHAMROCK PLZ STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-3537
Practice Address - Country:US
Practice Address - Phone:402-953-9180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE825101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)