Provider Demographics
NPI:1235490731
Name:BROWN, JUSTIN JOE
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:JOE
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 1:2433 E TROPICANA AVE
Mailing Address - Street 2:#181
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5416
Mailing Address - Country:US
Mailing Address - Phone:702-782-3711
Mailing Address - Fax:
Practice Address - Street 1:2433 E TROPICANA AVE
Practice Address - Street 2:#181
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5416
Practice Address - Country:US
Practice Address - Phone:702-782-3711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst