Provider Demographics
NPI:1386043578
Name:MONIQUE BROWN PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:MONIQUE BROWN PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:206-457-3092
Mailing Address - Street 1:3429 FREMONT PL N STE 303
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8650
Mailing Address - Country:US
Mailing Address - Phone:206-457-3092
Mailing Address - Fax:
Practice Address - Street 1:3429 FREMONT PL N STE 303
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8650
Practice Address - Country:US
Practice Address - Phone:206-457-3092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60444036103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty