Provider Demographics
NPI:1386043107
Name:BROWER, JOHN RICHARD
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
Last Name:BROWER
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 1:1214 GREYMONT AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2155
Mailing Address - Country:US
Mailing Address - Phone:601-201-5008
Mailing Address - Fax:
Practice Address - Street 1:1214 GREYMONT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2155
Practice Address - Country:US
Practice Address - Phone:601-201-5008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health