Provider Demographics
NPI:1346606829
Name:BROWN, VIKTOR LANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:VIKTOR
Middle Name:LANE
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-2409
Mailing Address - Country:US
Mailing Address - Phone:313-388-4100
Mailing Address - Fax:313-388-6566
Practice Address - Street 1:1110 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2409
Practice Address - Country:US
Practice Address - Phone:313-388-4100
Practice Address - Fax:313-388-6566
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003933103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical