Provider Demographics
NPI:1356480651
Name:BROWN, MARK LLOYD (LPC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:LLOYD
Last Name:BROWN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 E SUMMERS LN
Mailing Address - Street 2:
Mailing Address - City:SAINT DAVID
Mailing Address - State:AZ
Mailing Address - Zip Code:85630-6260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:70 E PATTON ST
Practice Address - Street 2:
Practice Address - City:SAINT DAVID
Practice Address - State:AZ
Practice Address - Zip Code:85630-6207
Practice Address - Country:US
Practice Address - Phone:520-720-4781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-1831101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor