Provider Demographics
NPI:1295190189
Name:BROWN, NATHAN (LCSW)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 MIDLAND DR STE 2
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-6825
Mailing Address - Country:US
Mailing Address - Phone:801-814-1618
Mailing Address - Fax:
Practice Address - Street 1:4645 MIDLAND DR STE 2
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:UT
Practice Address - Zip Code:84401-6825
Practice Address - Country:US
Practice Address - Phone:801-814-1618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4838377-35011041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical